Healthcare Provider Details

I. General information

NPI: 1013825413
Provider Name (Legal Business Name): NICHOLA RADER SPLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4959 PALO VERDE ST STE 109C
MONTCLAIR CA
91763-2358
US

IV. Provider business mailing address

4959 PALO VERDE ST STE 109C
MONTCLAIR CA
91763-2358
US

V. Phone/Fax

Practice location:
  • Phone: 909-971-3092
  • Fax: 909-971-3261
Mailing address:
  • Phone: 909-971-3092
  • Fax: 909-971-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: