Healthcare Provider Details

I. General information

NPI: 1679428718
Provider Name (Legal Business Name): PEEPAL TREETHERAPY AND HEARING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ALLEGRE CIR
CORONA CA
92879-8874
US

IV. Provider business mailing address

818 ALLEGRE CIR
CORONA CA
92879-8874
US

V. Phone/Fax

Practice location:
  • Phone: 917-312-2090
  • Fax:
Mailing address:
  • Phone: 917-312-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GOVARDHANACHARY VADLA
Title or Position: PRESIDENT
Credential: MASLP-CCC
Phone: 917-312-2090