MEDICARE: ADI S OZDOBA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	19843	CA

General Provider Information

NPI Number	:	1043584873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADI S OZDOBA CCC-SLP

Provider Business Mailing Address
First Line	:	111 SOURCE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-1370
Country	:	US
Telephone Number	:	949-939-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 WILSHIRE BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-2415
Country	:	US
Telephone Number	:	213-607-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	09/18/2025

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Directions to “ ADI S OZDOBA CCC-SLP” Practice Location

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