| Organization Name: | MILAGRO THERAPY SERVICES LLC |
| NPI Number: | 1124195540 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CYNTHIA J BONILLA (OCCUPATIONAL THERAPIST) |
| Mailing Address: | 220 Plaza St Las Vegas |
| State: | NM US |
| Postal Code: | 877013433 |
| Phone Number: | 5056991097 |
| Fax Number: | 5054549565 |
| NPI Enumeration Date: | 11/29/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2133 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | NM |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |