Provider Demographics
NPI:1518283886
Name:NINO, SANDRA ALICIA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ALICIA
Last Name:NINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:ALICIA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3300 TROSPER RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1328
Mailing Address - Country:US
Mailing Address - Phone:956-664-2525
Mailing Address - Fax:
Practice Address - Street 1:3300 TROSPER RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-1328
Practice Address - Country:US
Practice Address - Phone:956-664-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist