Provider Demographics
NPI:1316067523
Name:MORENO, MARLA MARI (BS STA)
Entity type:Individual
Prefix:MISS
First Name:MARLA
Middle Name:MARI
Last Name:MORENO
Suffix:
Gender:F
Credentials:BS STA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9471
Mailing Address - Country:US
Mailing Address - Phone:956-605-0597
Mailing Address - Fax:
Practice Address - Street 1:18360 FM 493
Practice Address - Street 2:LA BLANCA MEDICAL CTR. STE. # 3
Practice Address - City:LA BLANCA
Practice Address - State:TX
Practice Address - Zip Code:78558
Practice Address - Country:US
Practice Address - Phone:956-262-1192
Practice Address - Fax:956-262-9226
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330992355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant