Provider Demographics
NPI:1447627252
Name:ROSARIO-AGUILA, NELIENID (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NELIENID
Middle Name:
Last Name:ROSARIO-AGUILA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 SILVERSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-2242
Mailing Address - Country:US
Mailing Address - Phone:787-904-3924
Mailing Address - Fax:
Practice Address - Street 1:10335 US HIGHWAY 290 E
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-4686
Practice Address - Country:US
Practice Address - Phone:512-278-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115602235Z00000X
FLSZ7529235Z00000X
FLSA15670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR004076-1Medicaid
PR004076-1OtherFIRST MEDICAL