Provider Demographics
NPI:1316241128
Name:TATIS DE LEON, CARMEN MERCEDES (MS SLP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MERCEDES
Last Name:TATIS DE LEON
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 6 D-8
Mailing Address - Street 2:URB. VILLAS DEL SOL
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-4704
Mailing Address - Country:US
Mailing Address - Phone:787-467-2760
Mailing Address - Fax:
Practice Address - Street 1:CALLE 6 D-8
Practice Address - Street 2:URB VILLAS DEL SOL
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-4704
Practice Address - Country:US
Practice Address - Phone:787-467-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist