Provider Demographics
NPI:1649814567
Name:MORENO DE MACHUCA, DANIELA DENICE (SLP-A)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:DENICE
Last Name:MORENO DE MACHUCA
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:MACHUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-A
Mailing Address - Street 1:11922 PURE SILVER
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6226
Mailing Address - Country:US
Mailing Address - Phone:956-763-0645
Mailing Address - Fax:
Practice Address - Street 1:2011 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5945
Practice Address - Country:US
Practice Address - Phone:210-941-0967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370272355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant