=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932429032
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARLA FAYE GRACIA AUD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2010
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1261 W GREEN OAKS BLVD STE 105
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76013-8349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-451-4818
-----------------------------------------------------
Fax | 817-451-4828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8129 COLBI LN
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76120-5636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-915-6204
-----------------------------------------------------
Fax | 817-451-4828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 80225
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------