Provider Demographics
NPI:1104290469
Name:SEGARRA MIRANDA, IRIS YOMARA (THL)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:YOMARA
Last Name:SEGARRA MIRANDA
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 04 BOX 44024
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00669
Mailing Address - Country:UM
Mailing Address - Phone:787-949-3972
Mailing Address - Fax:
Practice Address - Street 1:F-18 URBANIZACION VILLA SERAL
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-949-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7742355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant