Healthcare Provider Details

I. General information

NPI: 1306041025
Provider Name (Legal Business Name): MARK M MOKE SLPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 E SAUNDERS ST SUITE 2
LAREDO TX
78041-5434
US

IV. Provider business mailing address

2335 E SAUNDERS ST SUITE 2
LAREDO TX
78041-5434
US

V. Phone/Fax

Practice location:
  • Phone: 956-791-4800
  • Fax: 956-791-4422
Mailing address:
  • Phone: 956-791-4800
  • Fax: 956-791-4422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number34024
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: