Provider Demographics
NPI:1104242676
Name:ROMERO MUNOZ, LIDIA RAQUEL (MS SPEECH PATHOLOGY)
Entity type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:RAQUEL
Last Name:ROMERO MUNOZ
Suffix:
Gender:
Credentials:MS SPEECH PATHOLOGY
Other - Prefix:PROF
Other - First Name:LIDIA
Other - Middle Name:RAQUEL
Other - Last Name:ROMERO-MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15120 MONTESINO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6731
Mailing Address - Country:US
Mailing Address - Phone:321-304-9289
Mailing Address - Fax:321-326-1022
Practice Address - Street 1:1514 SHALLCROSS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6842
Practice Address - Country:US
Practice Address - Phone:321-304-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-08
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15899235Z00000X, 235Z00000X
FLIMT 2513106H00000X
FLSI 25072355S0801X
FLSZ 7964235Z00000X
NY031788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant