Provider Demographics
NPI:1841908779
Name:CARRASQUILLO CARMONA, GEORLINE (SPEECH PATHOLOGY)
Entity type:Individual
Prefix:
First Name:GEORLINE
Middle Name:
Last Name:CARRASQUILLO CARMONA
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CONDO VEREDAS DEL RIO APT. 135
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-668-9026
Mailing Address - Fax:
Practice Address - Street 1:AVE. ROBERTO SANCHEZ
Practice Address - Street 2:VILELLA EDF. 903 LOCAL C-2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-0092
Practice Address - Country:US
Practice Address - Phone:787-460-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty