Provider Demographics
NPI:1124439138
Name:HERNANDEZ DE LA ROSA, LOURDES (SLP)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:HERNANDEZ DE LA ROSA
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 FOSS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4406
Mailing Address - Country:US
Mailing Address - Phone:502-416-8485
Mailing Address - Fax:
Practice Address - Street 1:4170 FOSS RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4406
Practice Address - Country:US
Practice Address - Phone:502-416-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14961235Z00000X
FLSZ7415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016131900Medicaid