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General NPI Number Information
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NPI Number | 1790083749
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Entity Type | Organization
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Legal Business Name | TBNI
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 3702 ROADRUNNER DR
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City | BREA
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State | CA
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Zip | 92823-1002
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Country | US
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Telephone | 714-989-6474
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Fax | 714-200-0234
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Provider Business Mailing Address
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Address Line | 3702 ROADRUNNER DR
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City | BREA
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State | CA
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Zip | 92823-1002
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Country | US
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Telephone | 714-989-6474
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Fax | 714-200-0234
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Authorized Official
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Title or Position | CFO
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Name | LEONARDO ENRIQUE DI GIACOMO
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Credential |
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Telephone | 714-989-6474
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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 |
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License Number State |
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