Healthcare Provider Details

I. General information

NPI: 1275873242
Provider Name (Legal Business Name): MARY LUZ ARENAS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 NW 96TH TER APT P
PEMBROKE PINES FL
33024-3042
US

IV. Provider business mailing address

2301 NW 96TH TER APT P
PEMBROKE PINES FL
33024-3042
US

V. Phone/Fax

Practice location:
  • Phone: 713-751-9111
  • Fax:
Mailing address:
  • Phone: 713-751-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number33519
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ7074
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 14722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: