Provider Demographics
NPI:1760745905
Name:DE LUCIO, AGUSTIN (SLP)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:
Last Name:DE LUCIO
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 PALM HVN
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4122
Mailing Address - Country:US
Mailing Address - Phone:956-459-8045
Mailing Address - Fax:956-688-6336
Practice Address - Street 1:525 PALM HVN
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4122
Practice Address - Country:US
Practice Address - Phone:956-459-8045
Practice Address - Fax:956-831-9931
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist