Healthcare Provider Details

I. General information

NPI: 1124152111
Provider Name (Legal Business Name): ANGELINA GUEREQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 VISCOUNT BLVD SUITE C-49
EL PASO TX
79925-5638
US

IV. Provider business mailing address

3605 SUNRISE AVE
EL PASO TX
79904-1808
US

V. Phone/Fax

Practice location:
  • Phone: 915-838-7604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number33488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: