Provider Demographics
NPI:1043611726
Name:MENDOZA, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MENDOZA
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 1:442 CALLE YUGO
Mailing Address - Street 2:BORINQUEN VALLEY 2
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:442 CALLE YUGO
Practice Address - Street 2:BORINQUEN VALLEY 2
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9585
Practice Address - Country:US
Practice Address - Phone:787-645-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13622355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant