Provider Demographics
NPI:1063515450
Name:FEBO, TOMAS (MS)
Entity type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:
Last Name:FEBO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STREET U-10
Mailing Address - Street 2:BERWIND STATES URB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-458-2911
Mailing Address - Fax:
Practice Address - Street 1:AVE FRAGOSO 4AS3
Practice Address - Street 2:VILLA FONTANA URB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-757-0620
Practice Address - Fax:787-762-2730
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR60028OtherTRIPLE C
PR4500005OtherHUMANA