MEDICARE: TRINITY THERAPY AND DIAGNOSTICIAN SERVICES, LLC

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1619850377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY THERAPY AND DIAGNOSTICIAN SERVICES, LLC

Provider Business Mailing Address
First Line	:	525 PALM HVN
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-4122
Country	:	US
Telephone Number	:	956-459-8045
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 PALM HVN
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-4122
Country	:	US
Telephone Number	:	956-459-8045
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AGUSTIN DE LUCIO
Credential	:	SLP
Telephone Number	:	956-459-8045

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	06/26/2026

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