Provider Demographics
NPI:1033692264
Name:RODRIGUEZ TARIN, SARAI JENIFFER (SLP)
Entity Type:Individual
Prefix:
First Name:SARAI
Middle Name:JENIFFER
Last Name:RODRIGUEZ TARIN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S FESTIVAL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5801
Mailing Address - Country:US
Mailing Address - Phone:915-842-1788
Mailing Address - Fax:915-842-1778
Practice Address - Street 1:109 S FESTIVAL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5801
Practice Address - Country:US
Practice Address - Phone:915-842-1788
Practice Address - Fax:915-842-1778
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty