Healthcare Provider Details

I. General information

NPI: 1164804332
Provider Name (Legal Business Name): STARS SPEECH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 H ST STE 6010
CHULA VISTA CA
91910-5565
US

IV. Provider business mailing address

333 H ST STE 6010
CHULA VISTA CA
91910-5565
US

V. Phone/Fax

Practice location:
  • Phone: 619-600-1395
  • Fax: 619-344-0469
Mailing address:
  • Phone: 619-600-1395
  • Fax: 619-344-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-9993
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8263
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21543
License Number StateCA

VIII. Authorized Official

Name: MR. CARLOS THOMAS GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 619-600-1395