Provider Demographics
NPI:1306953070
Name:NAVARRETE, SERGIO RUBEN (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:RUBEN
Last Name:NAVARRETE
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 BROWN ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4737
Mailing Address - Country:US
Mailing Address - Phone:915-533-3511
Mailing Address - Fax:
Practice Address - Street 1:1527 BROWN ST STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4737
Practice Address - Country:US
Practice Address - Phone:915-533-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist