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General NPI Number Information
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NPI Number | 1306088299
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Entity Type | Organization
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Legal Business Name | MI SUENO SPEECH THERAPY, INC.
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 203 E BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-2116
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Country | US
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Telephone | 626-732-1111
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Fax | 626-732-1112
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Provider Business Mailing Address
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Address Line | 203 E BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-2116
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Country | US
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Telephone | 626-732-1111
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Fax | 626-732-1112
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Authorized Official
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Title or Position | PRESIDENT/MS CCC-SLP
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Name | NORMA A LOPEZ-RIVERA
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Credential | MS
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Telephone | 626-732-1111
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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 | 15105
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License Number State | CA
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