Provider Demographics
NPI:1710509245
Name:FRONTERA-RODRIGUEZ, MARIA TERESA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:FRONTERA-RODRIGUEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 CALLE TULIPA
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3607
Mailing Address - Country:US
Mailing Address - Phone:787-599-4387
Mailing Address - Fax:
Practice Address - Street 1:1576 CALLE ENCARNACION
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4755
Practice Address - Country:US
Practice Address - Phone:787-708-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4203235Z00000X
GASLP011026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA061575862OtherDRIVERS LICENSE