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Individual

SUOMI LOPEZ GANDARA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SLP-A

Contact information

Practice address
5316 TRAIL LAKE DR, FORT WORTH, TX 76133-1931
(817) 292-8787
(817) 789-6849
Mailing address
745 VIA MIRAMONTE, MESQUITE, TX 75150-3055
(972) 686-3312

Taxonomy

Speciality
Code
Description
License number
State
2355A2700X
Audiology Assistant
Primary
35232
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
149984001
TX
Enumeration date
01/11/2010
Last updated
01/11/2010
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