Healthcare Provider Details

I. General information

NPI: 1962552935
Provider Name (Legal Business Name): BRENDA SANTA MARIA SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/21/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NORTH GARCIA STREET
ROMA TX
78584
US

IV. Provider business mailing address

597 N FM 3167
RIO GRANDE CITY TX
78582-6738
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-1616
  • Fax: 956-488-1819
Mailing address:
  • Phone: 569-735-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number101892
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: