Angelina Serrano
Individual provider Active NPI Speech-Language Pathologist · Superior, AZ
NPI 1205237807 · NPPES record last updated Sep 15, 2014
Key facts
- NPI
- 1205237807
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 571 W Gibbs St
Superior, AZ 85173-4005 - Phone
- (480) 620-2775
- NPI assigned
- Sep 15, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201217001009 | AZ | Practitioner - Qualified Speech Language Pathologist | 2668884529 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theracare PLLC | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
2830 E Brown Rd
Ste 1
Mesa, AZ 85213
Phone (480) 830-1188
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | AZ | Yes |
Addresses
Primary practice location
571 W Gibbs St
Superior, AZ 85173-4005
Mailing address
571 W Gibbs St
Superior, AZ 85173-4005
Phone (480) 620-2775
Other providers in Superior, AZ
- Karen F Melot
- Michael Morse
- Edward Anthony Ornelas
- Pinal County Arizona
- Natalie Rae Quiroz
- Superior Family Dental Care
- Town of Superior
- Timothy Hugh Vanderveen
All providers in Superior, AZ · Speech-Language Pathologist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.