Provider Demographics
NPI:1891106209
Name:ZEPEDA, KRISTINA
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:ZEPEDA
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 1:6650 SPRINGFIELD AVE STE#101
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6712
Mailing Address - Country:US
Mailing Address - Phone:956-725-4555
Mailing Address - Fax:956-725-3555
Practice Address - Street 1:6650 SPRINGFIELD AVE STE#101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6712
Practice Address - Country:US
Practice Address - Phone:956-725-4555
Practice Address - Fax:956-725-3555
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36614OtherSPEECH LANGUAGE PATHLOGY ASSISTANT