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NPI Code Detail

MEDICARE: ABRAZOS PEDIATRIC THERAPY PLLC

MEDICARE: ABRAZOS PEDIATRIC THERAPY PLLC
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
1261Q00000XClinic/Center
2261QH0700XHearing and Speech Clinic/Center
3235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1710462601
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABRAZOS PEDIATRIC THERAPY PLLC
Provider Business Mailing Address
First Line : 4849 N MESA ST STE 201
Second Line :
City : EL PASO
State : TX
Zip : 79912-5919
Country : US
Telephone Number : 915-351-6600
Fax Number :
Provider Business Practice Location Address
First Line : 7144 ALAMEDA AVE
Second Line :
City : EL PASO
State : TX
Zip : 79915-3502
Country : US
Telephone Number : 915-990-8683
Fax Number : 915-444-5908
Authorized Official
Title or Position : PRESIDENT
Name : ANA L MARTINEZ
Credential : CCC-SLP
Telephone Number : 915-351-6600
Provider Enumeration Date : 09/26/2018
Last Update Date : 01/09/2020

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Directions to “ABRAZOS PEDIATRIC THERAPY PLLC ” Practice Location

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