Provider Demographics
NPI:1053167619
Name:AGOSTO CUEVAS, JOMARYS AINNIZ (SPL)
Entity type:Individual
Prefix:
First Name:JOMARYS
Middle Name:AINNIZ
Last Name:AGOSTO CUEVAS
Suffix:
Gender:F
Credentials:SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#169 CALLE JAZMINE
Mailing Address - Street 2:URB. SABANERA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-692-3266
Mailing Address - Fax:
Practice Address - Street 1:PP14 CALLE 5
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-6240
Practice Address - Country:US
Practice Address - Phone:787-998-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4442235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist