Provider Demographics
NPI:1992094981
Name:PEKES EN DESARROLLO
Entity type:Organization
Organization Name:PEKES EN DESARROLLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA CLINICA/T.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVILAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTL
Authorized Official - Phone:787-292-2534
Mailing Address - Street 1:160 MARGINAL LAGO ALTO
Mailing Address - Street 2:PLAZA SAN MIGUEL 207
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3906
Mailing Address - Country:US
Mailing Address - Phone:787-292-2534
Mailing Address - Fax:
Practice Address - Street 1:160 MARGINAL LAGO ALTO
Practice Address - Street 2:PLAZA SAN MIGUEL 207
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3906
Practice Address - Country:US
Practice Address - Phone:787-292-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR689235Z00000X
PR810261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty