Healthcare Provider Details

I. General information

NPI: 1225816705
Provider Name (Legal Business Name): ALDRIN ALLEN YSIP M.A.,CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24328 VERMONT AVE STE 318
HARBOR CITY CA
90710-2314
US

IV. Provider business mailing address

1051 VIA NAVARRA
SAN PEDRO CA
90732-2308
US

V. Phone/Fax

Practice location:
  • Phone: 424-250-9615
  • Fax:
Mailing address:
  • Phone: 805-406-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number14317203
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: