Healthcare Provider Details

I. General information

NPI: 1336780659
Provider Name (Legal Business Name): HAI JIAO CUI RPE-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S ANAHEIM BLVD STE 150
ANAHEIM CA
92805-6205
US

IV. Provider business mailing address

1360 S ANAHEIM BLVD STE 150
ANAHEIM CA
92805-6205
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-1231
  • Fax:
Mailing address:
  • Phone: 714-776-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: