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General NPI Number Information
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NPI Number | 1447677190
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Entity Type | Individual
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Provider Name | MAYRA DORALI PEREZ M.S., CCC-SLO
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Gender | Female
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 3409 EXCECUTIVE CENTER DR
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City | AUSTIN
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State | TX
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Zip | 78731
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Country | US
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Telephone | 512-359-3703
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Fax |
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Provider Business Mailing Address
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Address Line | 20121 CHAYTON CIR
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-7795
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Country | US
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Telephone | 512-809-9604
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 102474
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License Number State | TX
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