Healthcare Provider Details

I. General information

NPI: 1922888197
Provider Name (Legal Business Name): SPEECH AND LANGUAGE DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43385 BUSINESS PARK DR STE 140
TEMECULA CA
92590-5517
US

IV. Provider business mailing address

43385 BUSINESS PARK DR STE 140
TEMECULA CA
92590-5517
US

V. Phone/Fax

Practice location:
  • Phone: 951-383-8505
  • Fax: 714-821-5683
Mailing address:
  • Phone:
  • Fax: 714-821-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DARREN SHAW
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 714-821-3620