Provider Demographics
NPI:1639852114
Name:SANTIAGO SERRANO, PAOLA GISELLE
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:GISELLE
Last Name:SANTIAGO SERRANO
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 1:198A AVE MONTEMAR
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5563
Mailing Address - Country:US
Mailing Address - Phone:787-616-8898
Mailing Address - Fax:
Practice Address - Street 1:198A AVE MONTEMAR
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5563
Practice Address - Country:US
Practice Address - Phone:787-616-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist