Provider Demographics
NPI:1952018665
Name:CASTRUITA, DIENNE MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:DIENNE
Middle Name:MARIE
Last Name:CASTRUITA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 LACEY OAK CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-2639
Mailing Address - Country:US
Mailing Address - Phone:575-571-2404
Mailing Address - Fax:
Practice Address - Street 1:5410 FREDERICKSBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3550
Practice Address - Country:US
Practice Address - Phone:210-541-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist