Provider Demographics
NPI:1508445321
Name:GALARZA LOPEZ, JACQUELINE N
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:N
Last Name:GALARZA LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSION DEL LAGO
Mailing Address - Street 2:124 CALLE LAGO CERRILLO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-438-3117
Mailing Address - Fax:
Practice Address - Street 1:URB. MARIANI
Practice Address - Street 2:2961 AVE. ROOSEVELT A-1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-438-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5930103TS0200X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool