Provider Demographics
NPI:1538464854
Name:RESTO, CARMEN HAYDEE (SLP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:HAYDEE
Last Name:RESTO
Suffix:
Gender:F
Credentials:SLP
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 719
Mailing Address - Street 2:
Mailing Address - City:PUERTO REAL
Mailing Address - State:PR
Mailing Address - Zip Code:00740-0719
Mailing Address - Country:US
Mailing Address - Phone:787-644-8814
Mailing Address - Fax:
Practice Address - Street 1:57 CELIS AGUILERA
Practice Address - Street 2:SUITE B
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-644-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR809235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist