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General NPI Number Information
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NPI Number | 1639671258
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Entity Type | Individual
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Provider Name | MARIZA RAQUEL VILLEGAS
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Gender | Female
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 2605 W MILE 5 RD # 5
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City | MISSION
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State | TX
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Zip | 78574-0968
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Country | US
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Telephone | 956-600-7098
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 TAMPA ST APT 2
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City | EDINBURG
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State | TX
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Zip | 78541-5925
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Country | US
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Telephone | 956-292-9352
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 34783
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License Number State | TX
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