Provider Demographics
NPI:1083257539
Name:PEREZ CARRASQUILLO, JACKELINE I (LICENCIADA)
Entity Type:Individual
Prefix:
First Name:JACKELINE
Middle Name:
Last Name:PEREZ CARRASQUILLO
Suffix:I
Gender:F
Credentials:LICENCIADA
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 1105
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1105
Mailing Address - Country:US
Mailing Address - Phone:787-513-4300
Mailing Address - Fax:
Practice Address - Street 1:URB. VILLAS DE TRUJILLO ALTO
Practice Address - Street 2:CALLE 2 NUM 29 A
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-513-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist