Provider Demographics
NPI:1356931034
Name:LEON, BIANMARIE MONTOSA (THL)
Entity type:Individual
Prefix:
First Name:BIANMARIE
Middle Name:MONTOSA
Last Name:LEON
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 8063
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-963-7924
Mailing Address - Fax:
Practice Address - Street 1:CARR. 123 MAGUEYES PR
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-598-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74062355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4994723OtherLICENCIA
PR4994723Medicaid
PR7406OtherPROFESIONAL LICENSE