Healthcare Provider Details

I. General information

NPI: 1922668706
Provider Name (Legal Business Name): RABLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7457
US

IV. Provider business mailing address

400 W VENTURA BLVD STE 150
CAMARILLO CA
93010-9140
US

V. Phone/Fax

Practice location:
  • Phone: 725-202-1497
  • Fax: 725-202-1500
Mailing address:
  • Phone: 804-383-1497
  • Fax: 805-383-1498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LINDSAY DETRING
Title or Position: GENERAL MANAGER
Credential:
Phone: 805-383-1497