Provider Demographics
NPI:1306331657
Name:CARRION-MUJICA, KARELYS NICOLLE (MS/SLP-CCC)
Entity type:Individual
Prefix:
First Name:KARELYS
Middle Name:NICOLLE
Last Name:CARRION-MUJICA
Suffix:
Gender:F
Credentials:MS/SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ED21 CALLE E4
Mailing Address - Street 2:URB BRISAS DEL MAR
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773
Mailing Address - Country:US
Mailing Address - Phone:787-205-7225
Mailing Address - Fax:
Practice Address - Street 1:ED21 CALLE E4
Practice Address - Street 2:URB BRISAS DEL MAR
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-205-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist