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General NPI Number Information
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NPI Number | 1184990822
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Entity Type | Individual
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Provider Name | SONAL PATHAK MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 706 N DIAMOND BAR BLVD STE B
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1059
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Country | US
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Telephone | 909-861-3423
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Fax |
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Provider Business Mailing Address
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Address Line | 6375 GREEN VALLEY CIR UNIT 306
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City | CULVER CITY
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State | CA
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Zip | 90230-8058
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Country | US
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Telephone | 310-699-9484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | SP19658
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License Number State | CA
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