Provider Demographics
NPI:1851704621
Name:HURTADO, FABIOLA
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:HURTADO
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 1:12501 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8999
Mailing Address - Country:US
Mailing Address - Phone:956-740-2818
Mailing Address - Fax:
Practice Address - Street 1:14515 BRIARHILLS PKWY
Practice Address - Street 2:#208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1000
Practice Address - Country:US
Practice Address - Phone:713-575-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX368632355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant