Provider Demographics
NPI:1083044671
Name:LUBILU THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:LUBILU THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:E
Authorized Official - Last Name:COSTAS VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-598-0323
Mailing Address - Street 1:CALLE 4 F7
Mailing Address - Street 2:URBANIZACION EL MADRIGAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1417
Mailing Address - Country:US
Mailing Address - Phone:787-598-0323
Mailing Address - Fax:
Practice Address - Street 1:4601 CALLE MIGUEL POU
Practice Address - Street 2:SECTOR REPARTO VILLA ALEGRE CARR 132 KM. 22.7
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-598-0323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty