Healthcare Provider Details

I. General information

NPI: 1891604294
Provider Name (Legal Business Name): RAVEENA BIRDEE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23640 REED WAY
HAYWARD CA
94541-7326
US

IV. Provider business mailing address

274 BELLEVIEW DR
SAN LEANDRO CA
94577-1706
US

V. Phone/Fax

Practice location:
  • Phone: 510-723-3880
  • Fax:
Mailing address:
  • Phone: 925-918-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: