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General NPI Number Information
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NPI Number | 1518208990
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Entity Type | Individual
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Provider Name | STEFANIE BURCIAGA MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 2920 INLAND EMPIRE BLVD STE 103
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City | ONTARIO
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State | CA
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Zip | 91764-5565
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Country | US
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Telephone | 909-235-9875
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Fax | 909-614-4922
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Provider Business Mailing Address
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Address Line | 2920 INLAND EMPIRE BLVD STE 103
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City | ONTARIO
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State | CA
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Zip | 91764-5565
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Country | US
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Telephone | 909-235-9875
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Fax | 909-614-4922
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SP1893
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP21941
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License Number State | CA
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