Healthcare Provider Details

I. General information

NPI: 1982186995
Provider Name (Legal Business Name): JULIAN H. ANZURES CCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7917 COUNTY ROAD 1005
GODLEY TX
76044-3324
US

IV. Provider business mailing address

7917 COUNTY ROAD 1005
GODLEY TX
76044-3324
US

V. Phone/Fax

Practice location:
  • Phone: 714-334-4653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: