Provider Demographics
NPI:1194504795
Name:SOTXAAC THERAPUETIC SERVICES LLC
Entity type:Organization
Organization Name:SOTXAAC THERAPUETIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:RODOLFO
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:SPEECH PATHOLOGIST
Authorized Official - Phone:956-455-5587
Mailing Address - Street 1:9475 LOS OLMOS
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4588
Mailing Address - Country:US
Mailing Address - Phone:956-455-5587
Mailing Address - Fax:956-594-6261
Practice Address - Street 1:9475 LOS OLMOS
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-4588
Practice Address - Country:US
Practice Address - Phone:956-455-5587
Practice Address - Fax:956-594-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty