Healthcare Provider Details

I. General information

NPI: 1487046090
Provider Name (Legal Business Name): JANICE HUOTARI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 VICILIA ST
GARDEN GROVE CA
92841-1631
US

IV. Provider business mailing address

11245 VICILIA ST
GARDEN GROVE CA
92841-1631
US

V. Phone/Fax

Practice location:
  • Phone: 714-293-7804
  • Fax:
Mailing address:
  • Phone: 714-293-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: