Healthcare Provider Details

I. General information

NPI: 1437604220
Provider Name (Legal Business Name): ASHLEY SEPEEDEH SOHRAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY SEPEEDEH TANARA

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD
PASADENA CA
91105-2544
US

IV. Provider business mailing address

2321 DOROTHY ST
LA CRESCENTA CA
91214-1512
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2700
  • Fax:
Mailing address:
  • Phone: 818-523-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: