Healthcare Provider Details

I. General information

NPI: 1124967831
Provider Name (Legal Business Name): KEVIN JAMES RHEA SLPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18837 BROOKHURST ST STE 109
FOUNTAIN VALLEY CA
92708-7301
US

IV. Provider business mailing address

3228 NEBRASKA PL
COSTA MESA CA
92626-2218
US

V. Phone/Fax

Practice location:
  • Phone: 714-861-9595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: