Healthcare Provider Details

I. General information

NPI: 1326491507
Provider Name (Legal Business Name): SASHA KHAWAJA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date: 03/28/2019
Reactivation Date: 04/10/2019

III. Provider practice location address

933 E DEODAR ST
ONTARIO CA
91764-1309
US

IV. Provider business mailing address

3180 E YOUNTVILLE DR
ONTARIO CA
91761-3860
US

V. Phone/Fax

Practice location:
  • Phone: 909-985-2731
  • Fax:
Mailing address:
  • Phone: 909-239-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: