Healthcare Provider Details

I. General information

NPI: 1184765893
Provider Name (Legal Business Name): ANGELICA CRYSTAL VALERO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10830 SILVERTON DR
CORPUS CHRISTI TX
78410-2241
US

IV. Provider business mailing address

600 COLLEGE STREET
PORTLAND TX
78374
US

V. Phone/Fax

Practice location:
  • Phone: 361-562-6031
  • Fax:
Mailing address:
  • Phone: 361-562-6031
  • Fax: 361-777-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number116012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: