=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386454700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL COMMUNICATION CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2025
-----------------------------------------------------
Last Update Date | 01/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3738 W 146TH ST
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-8457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-453-0134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3738 W 146TH ST
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90250-8457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-453-0134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | ANDRES HARO
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 213-453-0134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------