Healthcare Provider Details

I. General information

NPI: 1467275693
Provider Name (Legal Business Name): KIDSCARE THERAPIES A PROFESSIONAL SPEECH PATHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 E DORAN ST
GLENDALE CA
91206-2423
US

IV. Provider business mailing address

771 E DORAN ST
GLENDALE CA
91206-2423
US

V. Phone/Fax

Practice location:
  • Phone: 949-244-0816
  • Fax:
Mailing address:
  • Phone: 949-244-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ROUZAN DISHOIAN
Title or Position: OWNER/PRESIDENT
Credential: MS, CCC-SLP
Phone: 949-244-0816