Provider Demographics
NPI:1336449255
Name:CORREA PEREZ, CLARA IVETTE (PHL)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:IVETTE
Last Name:CORREA PEREZ
Suffix:
Gender:F
Credentials:PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 PARK STREET
Mailing Address - Street 2:HILL VIEW
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-385-8525
Mailing Address - Fax:
Practice Address - Street 1:618 PARK STREET
Practice Address - Street 2:HILL VIEW
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-385-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist