Provider Demographics
NPI:1275873242
Name:ARENAS, MARY LUZ (SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LUZ
Last Name:ARENAS
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 1:2301 NW 96TH TER
Mailing Address - Street 2:APT P
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3042
Mailing Address - Country:US
Mailing Address - Phone:713-751-9111
Mailing Address - Fax:
Practice Address - Street 1:2301 NW 96TH TER
Practice Address - Street 2:APT P
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3042
Practice Address - Country:US
Practice Address - Phone:713-751-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335192355S0801X
FLSZ7074235Z00000X
FLSA 14722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207164901Medicaid
TX149984001Medicaid
TX676535Medicare PIN
TX207164901Medicaid