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General NPI Number Information
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NPI Number | 1952712655
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Entity Type | Organization
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Legal Business Name | TUSTIN SPEECH THERAPY INC.
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 661 W 1ST ST SUITE E
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City | TUSTIN
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State | CA
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Zip | 92780-2939
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Country | US
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Telephone | 714-838-2853
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Fax |
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Provider Business Mailing Address
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Address Line | 661 W 1ST ST SUITE E
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City | TUSTIN
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State | CA
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Zip | 92780-2939
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Country | US
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Telephone | 714-838-2853
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MS. CHRISTINA L. SANTOYO
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Credential | C.C.C.
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Telephone | 714-331-3749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | SP12299
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License Number State | CA
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