Healthcare Provider Details

I. General information

NPI: 1235053562
Provider Name (Legal Business Name): TARA PETERS M.S. CCC, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6951 VANGUARD AVE
GARDEN GROVE CA
92845-1408
US

IV. Provider business mailing address

6951 VANGUARD AVE
GARDEN GROVE CA
92845-1408
US

V. Phone/Fax

Practice location:
  • Phone: 714-423-7620
  • Fax: 714-447-2853
Mailing address:
  • Phone: 714-423-7620
  • Fax: 714-447-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP14156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: