Provider Demographics
NPI:1386924603
Name:GRACIA, MARCOS R (AUD)
Entity type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:R
Last Name:GRACIA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W RANDOL MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4637
Mailing Address - Country:US
Mailing Address - Phone:817-277-7039
Mailing Address - Fax:817-801-3231
Practice Address - Street 1:101 W RANDOL MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4637
Practice Address - Country:US
Practice Address - Phone:817-277-7039
Practice Address - Fax:817-801-3231
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80381231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist