MEDICARE: ANA BEATRIZ MEDINA SLP ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	33892	TX

General Provider Information

NPI Number	:	1437290681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA BEATRIZ MEDINA SLP ASSISTANT

Provider Business Mailing Address
First Line	:	5751 BYLTHEWOOD ST
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77021-5401
Country	:	US
Telephone Number	:	713-741-5800
Fax Number	:	713-741-5805

Provider Business Practice Location Address
First Line	:	5751 BYLTHEWOOD ST
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77021-5401
Country	:	US
Telephone Number	:	713-741-5800
Fax Number	:	713-741-5805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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