Healthcare Provider Details

I. General information

NPI: 1568379279
Provider Name (Legal Business Name): MATIAS ESTEBAN MIRSCHWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W LINWOOD AVE
TURLOCK CA
95380-6220
US

IV. Provider business mailing address

1700 N TULLY RD APT G101
TURLOCK CA
95380-6872
US

V. Phone/Fax

Practice location:
  • Phone: 135-020-6270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: