Provider Demographics
NPI:1518633502
Name:CARRASQUILLO MERCADO, GABRIELA ALANIS (MS)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ALANIS
Last Name:CARRASQUILLO MERCADO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 CALLE 3 SE APT 109
Mailing Address - Street 2:CONDOMINIO MEDICAL PLAZA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3007
Mailing Address - Country:US
Mailing Address - Phone:787-617-0470
Mailing Address - Fax:
Practice Address - Street 1:CALLE ENCARNACION 1576
Practice Address - Street 2:URB CAPARRA HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-708-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004259235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist