Provider Demographics
NPI:1801594130
Name:GRAZIANI SANTANA, LAURA SOFIA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SOFIA
Last Name:GRAZIANI SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.REINA DE LOS ANGELES
Mailing Address - Street 2:M18 CALLE 7W
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-4030
Mailing Address - Country:US
Mailing Address - Phone:787-378-8270
Mailing Address - Fax:
Practice Address - Street 1:355 DE DIEGO AVE # 359
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1711
Practice Address - Country:US
Practice Address - Phone:787-723-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist