Healthcare Provider Details

I. General information

NPI: 1619851987
Provider Name (Legal Business Name): KRISTIN LEILANI URABE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 CRENSHAW BLVD
LOS ANGELES CA
90019-1938
US

IV. Provider business mailing address

3913 W 184TH ST
TORRANCE CA
90504-4809
US

V. Phone/Fax

Practice location:
  • Phone: 323-937-5466
  • Fax:
Mailing address:
  • Phone: 310-365-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: