Healthcare Provider Details

I. General information

NPI: 1972213056
Provider Name (Legal Business Name): ASHLEY BROOKE NIETO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY BROOKE PESEK SLP

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31505 OLD RIVER RD
BONSALL CA
92003-5112
US

IV. Provider business mailing address

103 JOYNER ST
OCEANSIDE CA
92058-7713
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-5200
  • Fax:
Mailing address:
  • Phone: 541-610-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: