Provider Demographics
NPI:1386805182
Name:PRIETO, DAGMAR E (MS PHL)
Entity type:Individual
Prefix:MRS
First Name:DAGMAR
Middle Name:E
Last Name:PRIETO
Suffix:
Gender:F
Credentials:MS PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 AVE AMERICO MIRANDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2213
Mailing Address - Country:US
Mailing Address - Phone:787-300-3840
Mailing Address - Fax:787-758-9381
Practice Address - Street 1:1136 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2213
Practice Address - Country:US
Practice Address - Phone:787-300-3840
Practice Address - Fax:787-758-9381
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist