Healthcare Provider Details

I. General information

NPI: 1730011347
Provider Name (Legal Business Name): FNU KADIONGA PETER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 N DIAMOND BAR BLVD STE B
DIAMOND BAR CA
91765-1059
US

IV. Provider business mailing address

2081 SYLVAN WAY APT 1011
LODI CA
95242-4441
US

V. Phone/Fax

Practice location:
  • Phone: 909-396-8900
  • Fax:
Mailing address:
  • Phone: 925-800-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: