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General NPI Number Information
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NPI Number | 1851738249
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Entity Type | Organization
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Legal Business Name | SPEECH AND LANGUAGE PEDIATRIC THERAPY,INC
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Dates
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Enumeration Date | 05/27/2013
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Last Update Date | 05/27/2013
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Provider Practice Location Address
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Address Line | 12001 SW 128TH CT STE 101
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City | MIAMI
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State | FL
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Zip | 33186-4665
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Country | US
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Telephone | 786-732-6983
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Fax | 786-732-6993
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Provider Business Mailing Address
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Address Line | 12001 SW 128TH CT STE 101
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City | MIAMI
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State | FL
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Zip | 33186-4665
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Country | US
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Telephone | 786-732-6983
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Fax | 786-732-6993
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSE M HERNANDEZ
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Credential | SPEECH LANGUAGE PATH
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Telephone | 786-732-6983
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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 | SZ6190
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License Number State | FL
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