Healthcare Provider Details

I. General information

NPI: 1306621735
Provider Name (Legal Business Name): THERAPY BUBBLE: SPEECH LANGUAGE PATHOLOGY SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10472 PAGO PAGO CIR
HUNTINGTON BEACH CA
92646-3026
US

IV. Provider business mailing address

10472 PAGO PAGO CIR
HUNTINGTON BEACH CA
92646-3026
US

V. Phone/Fax

Practice location:
  • Phone: 657-329-9807
  • Fax:
Mailing address:
  • Phone: 657-329-9807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GABRIELA CORTEZ
Title or Position: CO-OWNER/CO-DIRECTOR
Credential: SLP
Phone: 714-594-8719