Healthcare Provider Details

I. General information

NPI: 1912495276
Provider Name (Legal Business Name): SONALI DESAI SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 KELLER AVE STE 200
OAKLAND CA
94605-4229
US

IV. Provider business mailing address

PO BOX 2506
OCEANSIDE CA
92051-2506
US

V. Phone/Fax

Practice location:
  • Phone: 888-429-1415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5351
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1851853
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: