Provider Demographics
NPI:1063771467
Name:VALENTIN, ELISA I
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:I
Last Name:VALENTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 CALLE ALONSO DE OJEDA
Mailing Address - Street 2:PALACIOS DE MARBELLA
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5215
Mailing Address - Country:US
Mailing Address - Phone:787-636-3438
Mailing Address - Fax:
Practice Address - Street 1:11 CALLE PONCE
Practice Address - Street 2:URB PEREZ MORRIS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5004
Practice Address - Country:US
Practice Address - Phone:787-201-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1081235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist