Healthcare Provider Details

I. General information

NPI: 1992283543
Provider Name (Legal Business Name): LUZ M AVILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2018
Last Update Date: 08/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W SESAME DR
HARLINGEN TX
78550-7930
US

IV. Provider business mailing address

613 W SESAME DR
HARLINGEN TX
78550-7930
US

V. Phone/Fax

Practice location:
  • Phone: 956-399-4500
  • Fax: 956-399-4505
Mailing address:
  • Phone: 956-399-4500
  • Fax: 956-399-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number38114
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: