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General NPI Number Information
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NPI Number | 1487082285
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Entity Type | Organization
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Legal Business Name | MAZDA SPEECH LANGUAGE DEVELOPMENT CENTER
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Dates
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Enumeration Date | 10/15/2013
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 23504 LYONS AVE SUITE # 103B
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City | NEWHALL
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State | CA
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Zip | 91321-2500
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Country | US
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Telephone | 661-253-0245
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Fax | 661-253-0310
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Provider Business Mailing Address
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Address Line | 23504 LYONS AVE SUITE # 103B
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City | NEWHALL
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State | CA
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Zip | 91321-2500
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Country | US
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Telephone | 661-253-0245
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Fax | 661-253-0310
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Authorized Official
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Title or Position | OWNER
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Name | MS. PERVEEN M. KATRACK
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Credential | MS,CCC-SLP
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Telephone | 661-253-0245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SP17812
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License Number State | CA
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