Individual provider Active NPI

Virgilio Vazquez Garcia, SLP

  • Speech-Language Pathologist
  • Laredo, TX
National Provider Identifier
1609122415
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
106596 Issued in TX
Practice address
1405 Jacaman Rd Ste 106
Laredo, TX 78041-6225
Phone
(956) 608-3050
Fax
(956) 608-3097
NPI assigned
Jul 30, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 106596 TX Primary

Addresses

Primary practice location

1405 Jacaman Rd Ste 106
Laredo, TX 78041-6225

Mailing address

1405 Jacaman Rd Ste 106
Laredo, TX 78041-6225
Phone (956) 608-3050

Other identifiers 1

IdentifierTypeStateIssuer
2821076-01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220316001214 TX Practitioner - Qualified Speech Language Pathologist 0042605768 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
South Texas Direct Kids LLC Speech-Language Pathologist CurrentSince Jan 24, 2022 Accepting new patients
The Therapy Place, LLC Speech-Language Pathologist CurrentSince Sep 28, 2025 Accepting new patients
Safari Kids Rehabilitation Center,LLC Speech-Language Pathologist Past Accepting new patients

Locations

1405 Jacaman Rd
Ste 106
Laredo, TX 78041
Phone (956) 568-0003

1405 Jacaman Rd
Ste 102
Laredo, TX 78041
Phone (956) 602-1390

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1609122415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 JACAMAN RD STE 106",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780416225",
            "telephone_number": "956-608-3050",
            "fax_number": "956-608-3097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 JACAMAN RD STE 106",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780416225",
            "telephone_number": "956-608-3050",
            "fax_number": "956-608-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA",
        "first_name": "VIRGILIO",
        "middle_name": "VAZQUEZ",
        "name_prefix": "Mr.",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-30",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "106596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2821076-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laredo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.