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General NPI Number Information
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NPI Number | 1124165121
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Entity Type | Organization
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Legal Business Name | ROEL'S PEDIATRIC DEVELOPMENTAL SERVICES
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 1151 EL CENTRO ST SUITE B
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5721
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Country | US
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Telephone | 626-441-4445
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Fax | 626-441-4695
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Provider Business Mailing Address
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Address Line | 1151 EL CENTRO ST SUITE B
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5721
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Country | US
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Telephone | 626-441-4445
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Fax | 626-441-4695
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | CARMINA ZAVALA
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Credential |
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Telephone | 626-441-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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