Provider Demographics
NPI:1740413871
Name:GONZALEZ LUCCA, TANIA (SLP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:GONZALEZ LUCCA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6404
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-9781
Mailing Address - Country:US
Mailing Address - Phone:787-845-4045
Mailing Address - Fax:
Practice Address - Street 1:BO. PASO SECO SECTOR USERAS CARR 153 KM.7.5
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-0981
Practice Address - Country:US
Practice Address - Phone:787-845-4045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist