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General NPI Number Information
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NPI Number | 1467938647
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Entity Type | Organization
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Legal Business Name | OUTSHINE SPEECH THERAPY
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 2647 GATEWAY ROAD SUIT # 105
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City | CARLSBAD
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State | CA
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Zip | 92009
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Country | US
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Telephone | 760-410-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 2647 GATEWAY RD STE 105
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City | CARLSBAD
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State | CA
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Zip | 92009-1757
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Country | US
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Telephone | 760-410-8487
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Fax |
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Authorized Official
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Title or Position | PROGRAM COORDINATOR
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Name | SHABNAM MOEINI
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Credential | SPEECH THERAPIST
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Telephone | 760-410-8487
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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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