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General NPI Number Information
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NPI Number | 1750708574
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Entity Type | Organization
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Legal Business Name | THRIVE AND SHINE: SPEECH-LANGUAGE PATHOLOGY
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 8230 BEVERLY BLVD #30
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City | LOS ANGELES
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State | CA
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Zip | 90048-4528
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Country | US
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Telephone | 310-866-9958
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Fax |
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Provider Business Mailing Address
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Address Line | 8230 BEVERLY BLVD #30
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City | LOS ANGELES
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State | CA
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Zip | 90048-4528
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Country | US
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Telephone | 310-866-9958
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | NEDA REZAPOOR
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Credential |
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Telephone | 310-866-9958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 20444
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 20444
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License Number State | CA
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