Provider Demographics
NPI:1003362096
Name:SANDOVAL COLON, ISIS
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:SANDOVAL COLON
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 1:560 CALLE FLAMENCO
Mailing Address - Street 2:URB LOS MONTES
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-324-4497
Mailing Address - Fax:787-796-1631
Practice Address - Street 1:560 CALLE FLAMENCO
Practice Address - Street 2:URB LOS MONTES
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-324-4497
Practice Address - Fax:787-796-1631
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12662355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant