Provider Demographics
NPI:1912136318
Name:ECHEVARRIA ROMAN, MIOSOTIS (TH)
Entity Type:Individual
Prefix:
First Name:MIOSOTIS
Middle Name:
Last Name:ECHEVARRIA ROMAN
Suffix:
Gender:F
Credentials:TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364189
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4189
Mailing Address - Country:US
Mailing Address - Phone:787-813-1972
Mailing Address - Fax:787-813-1756
Practice Address - Street 1:1274 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0948
Practice Address - Country:US
Practice Address - Phone:787-813-1972
Practice Address - Fax:787-813-1756
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8622355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant