Healthcare Provider Details

I. General information

NPI: 1457122269
Provider Name (Legal Business Name): LEEHEIDE CINTRON AGOSTO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27-16 AVE ROBERTO CLEMENTE
CAROLINA PR
00985-5420
US

IV. Provider business mailing address

VILLAS DE CARRAIZO 379 CALLE 51
SAN JUAN PR
00926-9161
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax:
Mailing address:
  • Phone: 787-949-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6127157
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: