Provider Demographics
NPI:1770026536
Name:LA PUMA, MARCANTONIO
Entity Type:Individual
Prefix:
First Name:MARCANTONIO
Middle Name:
Last Name:LA PUMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CINCINNATI AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2610
Mailing Address - Country:US
Mailing Address - Phone:915-999-0516
Mailing Address - Fax:
Practice Address - Street 1:411 CINCINNATI AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2610
Practice Address - Country:US
Practice Address - Phone:915-999-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist