1285279968 NPI number — MAE BELENE AALA VITAL M.A., SLP

Table of content: MAE BELENE AALA VITAL M.A., SLP (NPI 1285279968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285279968 NPI number — MAE BELENE AALA VITAL M.A., SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VITAL
Provider First Name:
MAE BELENE
Provider Middle Name:
AALA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AALA
Provider Other First Name:
MAE BELENE
Provider Other Middle Name:
MANEJA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285279968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3976 S MANITOBA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91761-7934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
442-274-9970
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3976 S MANITOBA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91761-7934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
442-274-9970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2019

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: 235Z00000X , with the licence number:  13399 , 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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