Provider Demographics
NPI:1114542123
Name:CASTANEDA-DEL TORO, GLORYSABEL
Entity Type:Individual
Prefix:
First Name:GLORYSABEL
Middle Name:
Last Name:CASTANEDA-DEL TORO
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 1:5491 CALLE SURCO
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2442
Mailing Address - Country:US
Mailing Address - Phone:787-400-7025
Mailing Address - Fax:
Practice Address - Street 1:5491 CALLE SURCO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2442
Practice Address - Country:US
Practice Address - Phone:787-400-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2098OtherOTHER
PR2098Medicaid