1245620384 NPI number — THRIVE AND SHINE SPEECH THERAPY, INC.

Table of content: (NPI 1245620384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245620384 NPI number — THRIVE AND SHINE SPEECH THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THRIVE AND SHINE SPEECH THERAPY, INC.
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:
1245620384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90212-0215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-954-9614
Provider Business Mailing Address Fax Number:
310-526-6561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
292 S LA CIENEGA BLVD
Provider Second Line Business Practice Location Address:
#250
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-954-9614
Provider Business Practice Location Address Fax Number:
310-526-6561
Provider Enumeration Date:
01/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
REZAPOOR
Authorized Official First Name:
NEDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
310-866-9958

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  20444 , 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)





Copyright © 2007-2025 www.npivalidator.com