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General NPI Number Information
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NPI Number | 1982892139
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Entity Type | Organization
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Legal Business Name | STAR THERAPY SERVICES, INC.
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 414 TENNESSEE STREET, SUITE A
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City | RERLANDS
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State | CA
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Zip | 92373-5906
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Country | US
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Telephone | 909-910-4488
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Fax | 909-440-9093
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Provider Business Mailing Address
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Address Line | 29582 BRIGHT SPOT RD
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City | HIGHLAND
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State | CA
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Zip | 92346-5906
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Country | US
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Telephone | 909-910-4488
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Fax | 909-440-9093
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. STARLA AFFATATI
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Credential | M.S. CCC-SLP
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Telephone | 909-910-4488
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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 | SP9654
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License Number State | CA
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