Provider Demographics
NPI:1124705272
Name:BARRERA GOMEZ, FATIMA THAILY
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:THAILY
Last Name:BARRERA GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CAMILLE LN
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3039
Mailing Address - Country:US
Mailing Address - Phone:956-844-0703
Mailing Address - Fax:
Practice Address - Street 1:208 STARR ST STE 2
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2736
Practice Address - Country:US
Practice Address - Phone:956-514-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX431702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant