Healthcare Provider Details

I. General information

NPI: 1508790635
Provider Name (Legal Business Name): LONDON TUBEROSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 AUBURN AVE STE F/G
MONROE LA
71201-5008
US

IV. Provider business mailing address

5527 WHITES FERRY RD
WEST MONROE LA
71291-8871
US

V. Phone/Fax

Practice location:
  • Phone: 318-373-6324
  • Fax: 318-252-0630
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10153
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: