1548576168 NPI number — VALLEY SPEECH AND LANGUAGE REHABILITATION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548576168 NPI number — VALLEY SPEECH AND LANGUAGE REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY SPEECH AND LANGUAGE REHABILITATION, 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:
1548576168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2975
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL CENTRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92244-2975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-352-1628
Provider Business Mailing Address Fax Number:
760-352-1628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2366 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243-6176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-562-9286
Provider Business Practice Location Address Fax Number:
760-352-7628
Provider Enumeration Date:
08/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ-GOSTICH
Authorized Official First Name:
CINTHIA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
760-562-9286

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP 13118 , 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)

  • Identifier: 12075049 . This is a "AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SP 13118 . This is a "SPEECH -LANGUAGE PATHOLOGY AND AUDIOLOGY BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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