Provider Demographics
NPI:1033634142
Name:CHARNECO, SAMIR
Entity type:Individual
Prefix:MRS
First Name:SAMIR
Middle Name:
Last Name:CHARNECO
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:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0581
Mailing Address - Country:US
Mailing Address - Phone:787-354-8641
Mailing Address - Fax:
Practice Address - Street 1:HC 5 BOX 30395
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9581
Practice Address - Country:US
Practice Address - Phone:787-378-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist