1366529232 NPI number — MS. MAURICE KRISTINA CACERES CCC-SLP

Table of content: MS. MAURICE KRISTINA CACERES CCC-SLP (NPI 1366529232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366529232 NPI number — MS. MAURICE KRISTINA CACERES CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CACERES
Provider First Name:
MAURICE
Provider Middle Name:
KRISTINA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366529232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78540-3008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-289-6355
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 W EXPY 83
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-6516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-783-9000
Provider Business Practice Location Address Fax Number:
956-783-9131
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  105591 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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