Provider Demographics
NPI:1265783492
Name:TERCERO, REGINA DEPLATA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:DEPLATA
Last Name:TERCERO
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 1:11292 ACOMA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-2847
Mailing Address - Country:US
Mailing Address - Phone:915-328-5543
Mailing Address - Fax:
Practice Address - Street 1:11292 ACOMA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-2847
Practice Address - Country:US
Practice Address - Phone:915-328-5543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105840235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist