Provider Demographics
NPI:1609758192
Name:MATIAS, KALIL MIREILY
Entity type:Individual
Prefix:MRS
First Name:KALIL
Middle Name:MIREILY
Last Name:MATIAS
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:URB. HILLCREST VILLAGE #3009
Mailing Address - Street 2:CALLE PASEO DE LA PRADERA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-7002
Mailing Address - Country:US
Mailing Address - Phone:787-628-7691
Mailing Address - Fax:
Practice Address - Street 1:URB. HILLCREST VILLAGE #3009
Practice Address - Street 2:CALLE PASEO DE LA PRADERA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-7002
Practice Address - Country:US
Practice Address - Phone:787-628-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist