Provider Demographics
NPI:1033659099
Name:SARASUA, TONIROSE FUENTES (SLP-CF)
Entity Type:Individual
Prefix:MS
First Name:TONIROSE
Middle Name:FUENTES
Last Name:SARASUA
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 SERPA PL
Mailing Address - Street 2:APT C124
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-6434
Mailing Address - Country:US
Mailing Address - Phone:201-686-2503
Mailing Address - Fax:
Practice Address - Street 1:550 N SHERMAN ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3488
Practice Address - Country:US
Practice Address - Phone:775-423-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2017 PROVISIONAL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist