Provider Demographics
NPI:1194177303
Name:ACOSTA LARIOS, KARINA (SLP)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:ACOSTA LARIOS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PERKINS DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3248
Mailing Address - Country:US
Mailing Address - Phone:575-647-3773
Mailing Address - Fax:575-647-3777
Practice Address - Street 1:6601 MONTANA AVE STE G&H
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-838-7604
Practice Address - Fax:915-772-4633
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112588235Z00000X
NMSLP6557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist