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General NPI Number Information
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NPI Number | 1770983322
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Entity Type | Individual
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Provider Name | MINDI TENGAN
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Gender | Female
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 5312 BOLSA AVE STE 105
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-1060
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Country | US
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Telephone | 855-295-3276
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Fax | 818-241-6853
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Provider Business Mailing Address
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Address Line | PO BOX 768787
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City | ROSWELL
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State | GA
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Zip | 30076-8210
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Country | US
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Telephone | 818-241-6780
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Fax | 818-241-6853
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP23152
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License Number State | CA
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