Provider Demographics
NPI:1245420801
Name:ATEZ, MABEL ALTAGRACIA (MS CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MABEL
Middle Name:ALTAGRACIA
Last Name:ATEZ
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8052 DEERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9557
Mailing Address - Country:US
Mailing Address - Phone:813-383-8231
Mailing Address - Fax:
Practice Address - Street 1:500 7TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4820
Practice Address - Country:US
Practice Address - Phone:727-767-4141
Practice Address - Fax:727-767-6743
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist