Healthcare Provider Details

I. General information

NPI: 1114230687
Provider Name (Legal Business Name): MARIA IMELDA ZARRATE-AGUILAR B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 HOOKS AVE
DONNA TX
78537-3341
US

IV. Provider business mailing address

1205 HOOKS AVE
DONNA TX
78537-3341
US

V. Phone/Fax

Practice location:
  • Phone: 956-648-9565
  • Fax:
Mailing address:
  • Phone: 956-648-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12611
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: