Healthcare Provider Details

I. General information

NPI: 1710462601
Provider Name (Legal Business Name): ABRAZOS PEDIATRIC THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7144 ALAMEDA AVE
EL PASO TX
79915-3502
US

IV. Provider business mailing address

4849 N MESA ST STE 201
EL PASO TX
79912-5919
US

V. Phone/Fax

Practice location:
  • Phone: 915-990-8683
  • Fax: 915-444-5908
Mailing address:
  • Phone: 915-351-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ANA L MARTINEZ
Title or Position: PRESIDENT
Credential: CCC-SLP
Phone: 915-351-6600