Healthcare Provider Details

I. General information

NPI: 1336810779
Provider Name (Legal Business Name): 5678 COMMUNICATE SPEECH THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6377 RIVERSIDE AVE STE 203
RIVERSIDE CA
92506-3155
US

IV. Provider business mailing address

6377 RIVERSIDE AVE STE 203
RIVERSIDE CA
92506-3155
US

V. Phone/Fax

Practice location:
  • Phone: 951-892-0529
  • Fax:
Mailing address:
  • Phone: 951-892-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: ROLAND JUAREZ
Title or Position: OWNER
Credential:
Phone: 951-892-0529