Provider Demographics
NPI:1881077337
Name:LEBRON ROSADO, MARISELIS
Entity type:Individual
Prefix:
First Name:MARISELIS
Middle Name:
Last Name:LEBRON ROSADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CALLE JOBOS
Mailing Address - Street 2:BARRIADA BELGICA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1631
Mailing Address - Country:US
Mailing Address - Phone:787-601-1408
Mailing Address - Fax:
Practice Address - Street 1:2620 CALLE JOBOS
Practice Address - Street 2:BARRIADA BELGICA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1631
Practice Address - Country:US
Practice Address - Phone:787-783-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist