Provider Demographics
NPI:1780172452
Name:CARRION-LUGO, YARELIS (BS SLPA)
Entity type:Individual
Prefix:
First Name:YARELIS
Middle Name:
Last Name:CARRION-LUGO
Suffix:
Gender:F
Credentials:BS SLPA
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 9744
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-0744
Mailing Address - Country:US
Mailing Address - Phone:787-303-9662
Mailing Address - Fax:
Practice Address - Street 1:759 AVE AVELINO VICENTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2538
Practice Address - Country:US
Practice Address - Phone:787-303-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20862355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2086OtherSLT