Provider Demographics
NPI:1144757899
Name:SANTOS, NELLY MARILIS
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:MARILIS
Last Name:SANTOS
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. MONACO III CALLE REINIER #543
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00674
Mailing Address - Country:UM
Mailing Address - Phone:787-362-2862
Mailing Address - Fax:
Practice Address - Street 1:543 CALLE REINIER
Practice Address - Street 2:JARDINES DE MONACO III
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-362-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00415422355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6453133OtherFIRST MEDICAL
PR6453133OtherLEARN & GROW THERAPY GROUP