Basic Information
Provider Information
NPI: 1003141177
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DE LOS SANTOS
FirstName: SHARA
MiddleName: RENEE
NamePrefix: MRS.
NameSuffix:  
Credential: M.A., CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: DE LA GARZA
OtherFirstName: SHARA
OtherMiddleName: RENNE
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: M.A. SLP
OtherLastNameType: 1
Mailing Information
Address1: 2034 DAYLIGHT CRST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782305927
CountryCode: US
TelephoneNumber: 9562861174
FaxNumber:  
Practice Location
Address1: 1020 CENTRAL PKWY S
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782325021
CountryCode: US
TelephoneNumber: 1210798227
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/07/2009
LastUpdateDate: 10/07/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X104470TXY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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