Provider Demographics
NPI:1558245779
Name:DIAZ DE JESUS, GLADYS
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:DIAZ DE JESUS
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:A10 CALLE MARGINAL
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-3900
Mailing Address - Country:US
Mailing Address - Phone:787-909-6051
Mailing Address - Fax:
Practice Address - Street 1:A49 CALLE MARGINAL
Practice Address - Street 2:URBANIZACION BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3759
Practice Address - Country:US
Practice Address - Phone:787-801-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0020002355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant