Provider Demographics
NPI:1558986539
Name:VEGA TORRES, DIANA (CF-SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:VEGA TORRES
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 AIRPORT FWY STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-2378
Mailing Address - Country:US
Mailing Address - Phone:817-422-7604
Mailing Address - Fax:
Practice Address - Street 1:2701 AIRPORT FWY STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-2378
Practice Address - Country:US
Practice Address - Phone:682-564-5476
Practice Address - Fax:682-292-2930
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116737OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION