MEDICARE: LILIA MARGARITA POLO CONSUEGRA SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	SI8067	FL

General Provider Information

NPI Number	:	1538014725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIA MARGARITA POLO CONSUEGRA SR.

Provider Business Mailing Address
First Line	:	11404 NW 89TH AVE
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4100
Country	:	US
Telephone Number	:	786-576-1043
Fax Number	:

Provider Business Practice Location Address
First Line	:	11404 NW 89TH AVE
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4100
Country	:	US
Telephone Number	:	786-576-1043
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ LILIA MARGARITA POLO CONSUEGRA SR. ” Practice Location

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