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General NPI Number Information
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NPI Number | 1568886752
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Entity Type | Organization
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Legal Business Name | SMILE PEDIATRIC THERAPY & DIAGNOSTICS
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 5000 W SUNSET BLVD STE 510
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City | LOS ANGELES
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State | CA
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Zip | 90027-5864
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Country | US
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Telephone | 323-644-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 W SUNSET BLVD STE 510
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City | LOS ANGELES
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State | CA
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Zip | 90027-5864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | NICOLE HAJJAR
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Credential |
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Telephone | 323-644-9380
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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 | RPE8845
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License Number State | CA
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