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NPI Code Detail

MEDICARE: SARA ELIZABETH ITANI M.S., CCC-SLP

MEDICARE: SARA ELIZABETH ITANI M.S., 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 Pathologist18401CA

General Provider Information

NPI Number : 1477952141
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA ELIZABETH ITANI M.S., CCC-SLP
Provider Business Mailing Address
First Line : 1500 S HAVEN AVE STE 190
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2971
Country : US
Telephone Number : 909-390-1313
Fax Number : 909-390-1311
Provider Business Practice Location Address
First Line : 1500 S HAVEN AVE STE 190
Second Line :
City : ONTARIO
State : CA
Zip : 91761-2971
Country : US
Telephone Number : 909-390-1313
Fax Number : 909-390-1311
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2014
Last Update Date : 08/19/2014

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