Provider Demographics
NPI:1114181559
Name:GAMARRA-RIVERA, ANGELA ISABEL (MS CCCSLP)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:ISABEL
Last Name:GAMARRA-RIVERA
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE FLAMBOYAN #1187,
Mailing Address - Street 2:JARDIN BOTANICO SUR
Mailing Address - City:SAN JUAN
Mailing Address - State:TERRITORY
Mailing Address - Zip Code:00926-1117
Mailing Address - Country:UM
Mailing Address - Phone:787-764-6035
Mailing Address - Fax:787-754-8034
Practice Address - Street 1:CALLE FLAMBOYAN #1187,
Practice Address - Street 2:JARDIN BOTANICO SUR
Practice Address - City:SAN JUAN
Practice Address - State:TERRITORY
Practice Address - Zip Code:00926-1117
Practice Address - Country:UM
Practice Address - Phone:787-764-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist