Provider Demographics
NPI:1982186995
Name:ANZURES, JULIAN H (CCC)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:H
Last Name:ANZURES
Suffix:
Gender:M
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 COUNTY ROAD 1005
Mailing Address - Street 2:
Mailing Address - City:GODLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76044-3324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7917 COUNTY ROAD 1005
Practice Address - Street 2:
Practice Address - City:GODLEY
Practice Address - State:TX
Practice Address - Zip Code:76044-3324
Practice Address - Country:US
Practice Address - Phone:714-334-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist