Provider Demographics
NPI:1336423888
Name:READI DE LONG, MARGARET A (LAT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:A
Last Name:READI DE LONG
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAKE SPIER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3318
Mailing Address - Country:US
Mailing Address - Phone:915-346-4338
Mailing Address - Fax:
Practice Address - Street 1:3100 N LEE TREVINO DR STE B2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2098
Practice Address - Country:US
Practice Address - Phone:915-534-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist