MEDICARE: SRN SPEECH THERAPY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4021	TX

General Provider Information

NPI Number	:	1356713671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SRN SPEECH THERAPY, PC

Provider Business Mailing Address
First Line	:	6058 VIA DE LOS ARBOLES
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-1829
Country	:	US
Telephone Number	:	915-629-7663
Fax Number	:	915-629-7673

Provider Business Practice Location Address
First Line	:	6058 VIA DE LOS ARBOLES
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79932-1829
Country	:	US
Telephone Number	:	915-629-7663
Fax Number	:	915-629-7673

Authorized Official
Title or Position	:	PRESIDENT/ SPEECH LANGUAGE PATHOLOG
Name	:	MR. SERGIO RUBEN NAVARRETE
Credential	:	M.S. CCC-SLP
Telephone Number	:	915-329-9723

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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