Basic Information
Provider Information
NPI: 1467064337
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAMORA
FirstName: CELESTE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MS-CCC, SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1900 S JACKSON RD STE 3
Address2:  
City: MCALLEN
State: TX
PostalCode: 785031589
CountryCode: US
TelephoneNumber: 9566304400
FaxNumber: 9566304447
Practice Location
Address1: 1900 S JACKSON RD STE 3
Address2:  
City: MCALLEN
State: TX
PostalCode: 785031589
CountryCode: US
TelephoneNumber: 9566304400
FaxNumber: 9566304447
Other Information
ProviderEnumerationDate: 08/20/2020
LastUpdateDate: 08/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X115822TXY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


Home