1174853279 NPI number — MRS. MELANIE GARZA SPEECH LANGUAGE PATH

Table of content: MRS. MELANIE GARZA SPEECH LANGUAGE PATH (NPI 1174853279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174853279 NPI number — MRS. MELANIE GARZA SPEECH LANGUAGE PATH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARZA
Provider First Name:
MELANIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SPEECH LANGUAGE PATH
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:
1174853279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
865 ROCKY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYMONDVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78580-2816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-690-4141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 W SANTA ROSA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDCOUCH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-262-6015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2010

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:  103904 , 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)

  • Identifier: 103904 . This is a "STATE BOARD OF EXAMINERS FOR SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".