MEDICARE: SAFARI THERAPY GROUP

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

General Provider Information

NPI Number	:	1689505893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFARI THERAPY GROUP

Provider Business Mailing Address
First Line	:	11973 BANNER RUN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-0852
Country	:	US
Telephone Number	:	915-346-1616
Fax Number	:

Provider Business Practice Location Address
First Line	:	11973 BANNER RUN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-0852
Country	:	US
Telephone Number	:	915-346-1616
Fax Number	:

Authorized Official
Title or Position	:	SLP
Name	:	MS. JACQUELINE GUADALUPE PINA
Credential	:	M.A., CCC-SLP
Telephone Number	:	915-346-1616

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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Directions to “SAFARI THERAPY GROUP ” Practice Location

Language	Start Address	Practice Location

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