Provider Demographics
NPI:1548762057
Name:URIZA, MAYRA LETICIA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:LETICIA
Last Name:URIZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 MARIGOLD ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3154
Mailing Address - Country:US
Mailing Address - Phone:956-257-3867
Mailing Address - Fax:
Practice Address - Street 1:300 S 2ND ST STE A-B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2702
Practice Address - Country:US
Practice Address - Phone:956-683-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX380692355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant