Provider Demographics
NPI:1154866218
Name:GARCIA, GLADYS DAMARIS (MS)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:DAMARIS
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L17 CALLE 17
Mailing Address - Street 2:CIUDAD UNIVERSITARIA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3128
Mailing Address - Country:US
Mailing Address - Phone:787-637-0768
Mailing Address - Fax:
Practice Address - Street 1:1401 AVE SAN PATRICIO
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-501-5664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist