Provider Demographics
NPI:1144542614
Name:MONTALVO MARQUEZ, MERLIS JOHANNA (THL)
Entity type:Individual
Prefix:MISS
First Name:MERLIS
Middle Name:JOHANNA
Last Name:MONTALVO MARQUEZ
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CALLE SAN JOVINO
Mailing Address - Street 2:URB.SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4212
Mailing Address - Country:US
Mailing Address - Phone:787-747-1374
Mailing Address - Fax:
Practice Address - Street 1:421 CALLE SAN JOVINO
Practice Address - Street 2:URB.SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4212
Practice Address - Country:US
Practice Address - Phone:787-747-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant