Healthcare Provider Details

I. General information

NPI: 1881579944
Provider Name (Legal Business Name): ROSALYN MORA GARCIA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16320 ROSCOE BLVD
VAN NUYS CA
91406-1250
US

IV. Provider business mailing address

6320 CANOGA AVE # 15TH
WOODLAND HILLS CA
91367-2526
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: