Healthcare Provider Details

I. General information

NPI: 1801619358
Provider Name (Legal Business Name): YOUR VOICE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9641 DODSON WAY
VILLA PARK CA
92861
US

IV. Provider business mailing address

6285 E SPRING ST STE 106
LONG BEACH CA
90808-4020
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-4055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MAGNOLIA VELA
Title or Position: CEO
Credential:
Phone: 562-424-4055