Healthcare Provider Details

I. General information

NPI: 1154849834
Provider Name (Legal Business Name): MRS. STEPHANIE PAULA GELB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 VENICE BLVD
LOS ANGELES CA
90034-3216
US

IV. Provider business mailing address

3736 WATSEKA AVE APT 5
LOS ANGELES CA
90034-4032
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7115
  • Fax:
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: