MEDICARE: LEONOR GARCIA SLPA

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	37967	TX

General Provider Information

NPI Number	:	1932688835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONOR GARCIA SLPA

Provider Business Mailing Address
First Line	:	PO BOX 1027
Second Line	:
City	:	PENITAS
State	:	TX
Zip	:	78576-1027
Country	:	US
Telephone Number	:	956-458-8505
Fax Number	:

Provider Business Practice Location Address
First Line	:	5346 EAST HIGHWAY 83 UNIT 2 BUILDING A
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-7858
Country	:	US
Telephone Number	:	956-317-1282
Fax Number	:	956-317-1291

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

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	08/10/2018

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