Provider Demographics
NPI:1104475813
Name:TANDOC PALISOC, MARLON
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:TANDOC PALISOC
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 DANA MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-1727
Mailing Address - Country:US
Mailing Address - Phone:915-777-2758
Mailing Address - Fax:
Practice Address - Street 1:12440 ROJAS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-5261
Practice Address - Country:US
Practice Address - Phone:915-937-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116240235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist