Provider Demographics
NPI:1598118564
Name:SERVICIOS TERAPEUTICOS MAYARI, INC.
Entity Type:Organization
Organization Name:SERVICIOS TERAPEUTICOS MAYARI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:AISSA
Authorized Official - Last Name:MATTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:787-780-6006
Mailing Address - Street 1:SANTA ROSA MALL
Mailing Address - Street 2:OFIC 202B
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-780-6006
Mailing Address - Fax:
Practice Address - Street 1:SANTA ROSA MALL
Practice Address - Street 2:OFIC 202B
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0000
Practice Address - Country:US
Practice Address - Phone:787-780-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR626174400000X
PR0155174400000X
PR003174400000X
PR237174400000X
PR723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty