Provider Demographics
NPI:1417413295
Name:NEVAREZ, LAIZA GIOANNA (STA)
Entity Type:Individual
Prefix:
First Name:LAIZA
Middle Name:GIOANNA
Last Name:NEVAREZ
Suffix:
Gender:F
Credentials:STA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5939 OLEASTER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2345
Mailing Address - Country:US
Mailing Address - Phone:661-400-8232
Mailing Address - Fax:
Practice Address - Street 1:444 EXECUTIVE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1058
Practice Address - Country:US
Practice Address - Phone:661-400-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX404512355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty