Provider Demographics
NPI:1235893116
Name:ALDERETE, JUAN ANTONIO IV (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ANTONIO
Last Name:ALDERETE
Suffix:IV
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12198 BRADBURY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-8616
Mailing Address - Country:US
Mailing Address - Phone:915-504-2717
Mailing Address - Fax:
Practice Address - Street 1:14521 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-8564
Practice Address - Country:US
Practice Address - Phone:915-926-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX117275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist