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NPI Code Detail

MEDICARE: IRMA CONDONG M.A., CCC-SLP

MEDICARE:   IRMA  CONDONG  M.A., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist16521CA

General Provider Information

NPI Number : 1033478193
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRMA CONDONG M.A., CCC-SLP
Provider Business Mailing Address
First Line : 11152 LEXINGTON DR
Second Line :
City : LOS ALAMITOS
State : CA
Zip : 90720-3722
Country : US
Telephone Number : 510-366-0039
Fax Number :
Provider Business Practice Location Address
First Line : 3521 LOMITA BLVD
Second Line : SUITE 201
City : TORRANCE
State : CA
Zip : 90505-5039
Country : US
Telephone Number : 310-856-8528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2012
Last Update Date : 12/14/2021

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Directions to “ IRMA CONDONG M.A., CCC-SLP” Practice Location

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