Provider Demographics
NPI:1518713908
Name:VASSALLO, CARLA S
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:S
Last Name:VASSALLO
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:PO BOX 800356
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0356
Mailing Address - Country:US
Mailing Address - Phone:787-400-2301
Mailing Address - Fax:
Practice Address - Street 1:756 CALLE DUKE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4139
Practice Address - Country:US
Practice Address - Phone:787-400-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty