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General NPI Number Information
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NPI Number | 1891356259
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Entity Type | Individual
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Provider Name | JEFF LLOYD TOMILLOSO M.S. SLP-CF
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Gender | Male
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 500 W CENTRAL AVE # 528
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City | BREA
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State | CA
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Zip | 92821-3027
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Country | US
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Telephone | 714-529-5022
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Fax |
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Provider Business Mailing Address
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Address Line | 1908 PIEDMONT
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City | IRVINE
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State | CA
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Zip | 92620-3800
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Country | US
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Telephone | 707-386-2723
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Fax |
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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 | 13480
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License Number State | CA
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