Basic Information
| Provider Information | |||||||||
| NPI: | 1376739607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ DUQUE | ||||||||
| FirstName: | MARIBEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A., CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2805 FOUNTAIN PLAZA BLVD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785398031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563162224 | ||||||||
| FaxNumber: | 9563160445 | ||||||||
| Practice Location | |||||||||
| Address1: | 4301 MILE 8 RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785415127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563690350 | ||||||||
| FaxNumber: | 9565870245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 19444 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.