Provider Demographics
NPI:1962612226
Name:BURGOS RODRIGUEZ, MAYRA JEANETTE (AUD)
Entity type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:JEANETTE
Last Name:BURGOS RODRIGUEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 561835
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-4275
Mailing Address - Country:US
Mailing Address - Phone:787-259-2311
Mailing Address - Fax:787-259-2311
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:COND. SAN VICENTE SUITE 205
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1554
Practice Address - Country:US
Practice Address - Phone:787-259-2311
Practice Address - Fax:787-259-2311
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0491231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist