Healthcare Provider Details

I. General information

NPI: 1932429032
Provider Name (Legal Business Name): MARLA FAYE GRACIA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 W GREEN OAKS BLVD STE 105
ARLINGTON TX
76013-8349
US

IV. Provider business mailing address

8129 COLBI LN
FORT WORTH TX
76120-5636
US

V. Phone/Fax

Practice location:
  • Phone: 817-451-4818
  • Fax: 817-451-4828
Mailing address:
  • Phone: 440-915-6204
  • Fax: 817-451-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number80225
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: