Provider Demographics
NPI:1639651946
Name:BALDERAS, NIZA IRENE (SPEECH ASSISTANT)
Entity Type:Individual
Prefix:
First Name:NIZA
Middle Name:IRENE
Last Name:BALDERAS
Suffix:
Gender:F
Credentials:SPEECH ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5346 E US HIGHWAY 83 STE 2
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-9418
Mailing Address - Country:US
Mailing Address - Phone:956-317-1282
Mailing Address - Fax:956-317-1291
Practice Address - Street 1:5346 EAST HIGHWAY 83 UNIT 2 BUILDING A
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-7858
Practice Address - Country:US
Practice Address - Phone:956-317-1282
Practice Address - Fax:956-317-1291
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty