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General NPI Number Information
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NPI Number | 1104621846
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Entity Type | Organization
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Legal Business Name | HERITAGE SPEECH THERAPY INC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 17802 SKY PARK CIR STE 104
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City | IRVINE
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State | CA
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Zip | 92614-6405
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Country | US
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Telephone | 949-771-5881
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Fax | 949-271-4904
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Provider Business Mailing Address
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Address Line | 17802 SKY PARK CIR STE 104
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City | IRVINE
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State | CA
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Zip | 92614-6405
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Country | US
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Telephone | 949-771-5881
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Fax | 949-271-4904
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | JONATHAN NGUYEN
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Credential |
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Telephone | 949-771-5881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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