Provider Demographics
NPI:1962128934
Name:AMIGOS SPEECH THERAPY
Entity type:Organization
Organization Name:AMIGOS SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:MARISELL
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA-MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-938-6028
Mailing Address - Street 1:310 CALLE LUIS FELIPE CALERO
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-6110
Mailing Address - Country:US
Mailing Address - Phone:787-938-6028
Mailing Address - Fax:
Practice Address - Street 1:310 CALLE LUIS FELIPE CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-6110
Practice Address - Country:US
Practice Address - Phone:787-938-6028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty