Provider Demographics
NPI:1629422399
Name:GUERRERO DIAZ, CALINES CAMILLE
Entity Type:Individual
Prefix:
First Name:CALINES
Middle Name:CAMILLE
Last Name:GUERRERO DIAZ
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 1:619 CALLE CUENCA
Mailing Address - Street 2:URB. PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-5118
Mailing Address - Country:US
Mailing Address - Phone:787-239-2714
Mailing Address - Fax:
Practice Address - Street 1:2510 WESTCHESTER AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3585
Practice Address - Country:US
Practice Address - Phone:718-597-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist