Provider Demographics
NPI:1528382322
Name:PENA-GONZALEZ, JULIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PENA-GONZALEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 CATCLAW DR
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-4836
Mailing Address - Country:US
Mailing Address - Phone:956-735-5058
Mailing Address - Fax:956-486-2675
Practice Address - Street 1:511 W 2ND ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3609
Practice Address - Country:US
Practice Address - Phone:956-735-5058
Practice Address - Fax:956-486-2675
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist