1124303086 NPI number — LIL' BLOOMERS SPEECH THERAPY CLINIC

Table of content: MS. VICTORIA TEMPLE JAMES R.D. (NPI 1073936209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124303086 NPI number — LIL' BLOOMERS SPEECH THERAPY CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIL' BLOOMERS SPEECH THERAPY CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124303086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
337 S BEVERLY DR
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90212-4315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-545-2566
Provider Business Mailing Address Fax Number:
888-545-2566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 S BEVERLY DR
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90212-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-545-2566
Provider Business Practice Location Address Fax Number:
888-545-2566
Provider Enumeration Date:
10/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREW
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER / SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
888-545-2566

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  15011 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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