Provider Demographics
NPI:1942440466
Name:TANGUMA, KARINA JOHANA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARINA
Middle Name:JOHANA
Last Name:TANGUMA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 ALA BLANCA ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6628
Mailing Address - Country:US
Mailing Address - Phone:956-240-8090
Mailing Address - Fax:
Practice Address - Street 1:2105 W 3 MILE RD UNIT 5
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-6732
Practice Address - Country:US
Practice Address - Phone:956-581-7172
Practice Address - Fax:956-581-7130
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1942440466Medicaid
TX200319601Medicaid
TX1942440466Medicaid