Provider Demographics
NPI:1750772588
Name:MALDONADO SANTIAGO, LUCYBETH (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:LUCYBETH
Middle Name:
Last Name:MALDONADO SANTIAGO
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAS COLINAS S 1 CALLE TRES PISTACHOS
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-203-9243
Mailing Address - Fax:
Practice Address - Street 1:URB SANTA ROSA 11-16
Practice Address - Street 2:CARRETERA 174
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6609
Practice Address - Country:US
Practice Address - Phone:787-510-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist