Healthcare Provider Details

I. General information

NPI: 1457094104
Provider Name (Legal Business Name): KID'S PATH PEDIATRIC THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 E FLORENCE AVE
LOS ANGELES CA
90001-2109
US

IV. Provider business mailing address

2355 WESTWOOD BLVD # 965
LOS ANGELES CA
90064-2109
US

V. Phone/Fax

Practice location:
  • Phone: 310-210-3196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIFFANY NAVIDBAKHSH
Title or Position: CEO/FOUNDER
Credential:
Phone: 310-824-3594