Healthcare Provider Details

I. General information

NPI: 1912813841
Provider Name (Legal Business Name): KRISTIE COMPAU
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33122 VALLE RD
SAN JUAN CAPISTRANO CA
92675-4853
US

IV. Provider business mailing address

22 GOLDMINE ST
TRABUCO CANYON CA
92679-5335
US

V. Phone/Fax

Practice location:
  • Phone: 949-234-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number29877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: