Provider Demographics
NPI:1134986912
Name:VALDES DIAZ, LAURA M (SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:VALDES DIAZ
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 1:9639 VILLA DE CIUDAD JARDIN
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PA
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 CALLE DR FERNANDEZ
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-5939
Practice Address - Country:US
Practice Address - Phone:787-678-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist