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1013845478 NPI number — SAMAD CYRUS M.S., CCC-SLP

NPI Number: 1013845478
Health Care Provider/Practitioner: SAMAD CYRUS M.S., CCC-SLP

Information about “1013845478” NPI (SAMAD CYRUS M.S., CCC-SLP) exists in 1013845478 in HTML format HTML  |  1013845478 in plain Text format TXT  |  1013845478 in PDF (Portable Document Format) PDF  |  1013845478 in an XML format XML  formats.

NPI Number : 1013845478 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013845478",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CYRUS",
    "FirstName": "SAMAD",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S., CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8446 PERIWINKLE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BUENA PARK",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90620-2119",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "714-308-3004",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5350 FAIRMONT BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "YORBA LINDA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92886-4446",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "714-986-7400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/13/2026",
    "LastUpdateDate": "05/13/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "SP30716",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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