1790562098 NPI number — MS. DEIDRA DENISE TAFOLLA SLP

Table of content: MS. DEIDRA DENISE TAFOLLA SLP (NPI 1790562098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790562098 NPI number — MS. DEIDRA DENISE TAFOLLA SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAFOLLA
Provider First Name:
DEIDRA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1790562098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8946 ANDERSON RD
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:
78542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-720-3414
Provider Business Mailing Address Fax Number:
956-565-9686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EASTER SEASLS RIO GRANDE VALLEY
Provider Second Line Business Practice Location Address:
1217 W. HOUSTON AVE
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78501-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-631-9171
Provider Business Practice Location Address Fax Number:
956-631-7566
Provider Enumeration Date:
09/11/2023

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:  121723 , 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)