Healthcare Provider Details

I. General information

NPI: 1043939853
Provider Name (Legal Business Name): NATASHA ALEXANDRA LASSALLE PINEIRO THL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 59 HM5 SECTOR TIBURON
BARCELONETA PR
00617
US

IV. Provider business mailing address

HC 3 BOX 20599
ARECIBO PR
00612-8165
US

V. Phone/Fax

Practice location:
  • Phone: 787-372-3736
  • Fax:
Mailing address:
  • Phone: 787-452-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7205
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: