Provider Demographics
NPI:1598245177
Name:RUBALCABA, LAURISA YVETTE (SLP- INTERN)
Entity type:Individual
Prefix:
First Name:LAURISA
Middle Name:YVETTE
Last Name:RUBALCABA
Suffix:
Gender:F
Credentials:SLP- INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 LOS ALAMOS CIR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-5617
Mailing Address - Country:US
Mailing Address - Phone:956-784-2077
Mailing Address - Fax:956-587-0245
Practice Address - Street 1:3920 MICKEY GILLEY BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3005
Practice Address - Country:US
Practice Address - Phone:713-740-0023
Practice Address - Fax:713-740-4008
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346682355S0801X
TX121976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant