Provider Demographics
NPI:1760705610
Name:PEGUERO CABRERA, LEOTILDE
Entity Type:Individual
Prefix:
First Name:LEOTILDE
Middle Name:
Last Name:PEGUERO CABRERA
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 1:758 BRADY AVE APT 411
Mailing Address - Street 2:APT. 411
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2766
Mailing Address - Country:US
Mailing Address - Phone:718-794-9383
Mailing Address - Fax:718-790-9092
Practice Address - Street 1:758 BRADY AVE APT 411
Practice Address - Street 2:APT. 411
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2766
Practice Address - Country:US
Practice Address - Phone:718-794-9383
Practice Address - Fax:718-790-9092
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency