Healthcare Provider Details

I. General information

NPI: 1518613397
Provider Name (Legal Business Name): SOCAL SPEECH THERAPY & SWALLOWING DIAGNOSTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4383 TUJUNGA AVE STE J
STUDIO CITY CA
91604-2771
US

IV. Provider business mailing address

11239 VENTURA BLVD STE 103
STUDIO CITY CA
91604-3164
US

V. Phone/Fax

Practice location:
  • Phone: 818-824-3070
  • Fax: 818-301-3282
Mailing address:
  • Phone: 818-824-3070
  • Fax: 818-301-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN JOSEPH MILLER
Title or Position: ADMINISTRATOR
Credential: MA
Phone: 818-824-3070