Provider Demographics
NPI:1932800463
Name:DELOSA, LEA
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:DELOSA
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 1:8196 VIA DI VENETO
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1974
Mailing Address - Country:US
Mailing Address - Phone:561-397-2239
Mailing Address - Fax:
Practice Address - Street 1:8196 VIA DI VENETO
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1974
Practice Address - Country:US
Practice Address - Phone:561-397-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA21028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist