1235573304 NPI number — MRS. SUZANNE RENEE MOLERA B.A COMM. DISORDERS

Table of content: MRS. SUZANNE RENEE MOLERA B.A COMM. DISORDERS (NPI 1235573304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235573304 NPI number — MRS. SUZANNE RENEE MOLERA B.A COMM. DISORDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLERA
Provider First Name:
SUZANNE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.A COMM. DISORDERS
Provider Gender Code:
F

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:
1235573304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24602 VIA VALLARTA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORBA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-692-9563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 OLD SPRINGS RD., STE. 100
Provider Second Line Business Practice Location Address:
ANAHEIM HILLS SPEECH AND LANGUAGE CENTER
Provider Business Practice Location Address City Name:
ANAHEIM HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-282-8852
Provider Business Practice Location Address Fax Number:
714-282-8876
Provider Enumeration Date:
04/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SPA 170 , 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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