Provider Demographics
NPI:1043562614
Name:CARTAGENA-CALDERON, LOURDES MILAGROS (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:MILAGROS
Last Name:CARTAGENA-CALDERON
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 1:5119 PIAZZA LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8011
Mailing Address - Country:US
Mailing Address - Phone:407-288-6368
Mailing Address - Fax:
Practice Address - Street 1:5119 PIAZZA LOOP
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771
Practice Address - Country:US
Practice Address - Phone:407-288-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL530312Medicaid