MEDICARE: ELIZABETH AGUILAR-DESIDERIO

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	235Z00000X	Speech-Language Pathologist	108318	TX
2	235Z00000X	Speech-Language Pathologist	20001	CA

General Provider Information

NPI Number	:	1689088213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH AGUILAR-DESIDERIO

Provider Business Mailing Address
First Line	:	5350 OLD DOWLEN RD APT 421
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-6629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 INTERSTATE 10 N STE 225
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77707-2549
Country	:	US
Telephone Number	:	409-835-0228
Fax Number	:	409-835-0151

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

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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Directions to “ ELIZABETH AGUILAR-DESIDERIO ” Practice Location

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