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General NPI Number Information
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NPI Number | 1790341931
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Entity Type | Organization
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Legal Business Name | PREFERRED PRACTICE SPEECH PATHOLOGY, APC
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 879 W 190TH ST
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City | GARDENA
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State | CA
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Zip | 90248-4220
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Country | US
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Telephone | 310-890-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 541 W ATHENS BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90044-3916
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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 | OWNER
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Name | MRS. LORNA MANUEL MOTEN
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Credential | CCC-SLP
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Telephone | 310-890-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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