Provider Demographics
NPI:1003539172
Name:VIDAURRI, DEBORAH E
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:VIDAURRI
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 1:2250 PUE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2823
Mailing Address - Country:US
Mailing Address - Phone:210-473-7705
Mailing Address - Fax:
Practice Address - Street 1:15526 BAYAKOA CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-3179
Practice Address - Country:US
Practice Address - Phone:210-473-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist