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NPI Code Detail

MEDICARE: FIRST EXPRESSIONS SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.

MEDICARE: FIRST EXPRESSIONS SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.
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
1225100000XPhysical Therapist
2225X00000XOccupational Therapist
3235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1053945972
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRST EXPRESSIONS SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.
Provider Business Mailing Address
First Line : 27720 JEFFERSON AVE STE 120
Second Line :
City : TEMECULA
State : CA
Zip : 92590-2609
Country : US
Telephone Number : 951-587-6973
Fax Number : 844-332-5907
Provider Business Practice Location Address
First Line : 4193 FLAT ROCK DR STE 200
Second Line :
City : RIVERSIDE
State : CA
Zip : 92505-7113
Country : US
Telephone Number : 619-807-4336
Fax Number :
Authorized Official
Title or Position : SPEECH-LANGUAGE PATHOLOGIST
Name : MR. JASON R. BERGANCIA
Credential : MA., CCC-SLP
Telephone Number : 619-807-4336
Provider Enumeration Date : 02/29/2020
Last Update Date : 03/21/2022

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