Provider Demographics
NPI:1295967883
Name:CARVAJAL, LOURDES IRENE (SLP)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:IRENE
Last Name:CARVAJAL
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 1:9164 NW 149TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-8058
Mailing Address - Country:US
Mailing Address - Phone:305-331-6126
Mailing Address - Fax:305-556-1007
Practice Address - Street 1:9164 NW 149TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-8058
Practice Address - Country:US
Practice Address - Phone:305-331-6126
Practice Address - Fax:305-556-1007
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 10702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist