Provider Demographics
NPI:1174040778
Name:CORREA VAZQUEZ, JULIANA I
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:I
Last Name:CORREA VAZQUEZ
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 193069
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3069
Mailing Address - Country:US
Mailing Address - Phone:787-761-0036
Mailing Address - Fax:787-292-5050
Practice Address - Street 1:EL MOLINO SHOPPING CENTER
Practice Address - Street 2:LOCAL 1111, PR 54
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-3688
Practice Address - Fax:787-491-0286
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10112355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant