MEDICARE: MISA PRIEST

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	20816	CA

General Provider Information

NPI Number	:	1083336838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISA PRIEST

Provider Business Mailing Address
First Line	:	3265 S SEPULVEDA BLVD APT 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-5219
Country	:	US
Telephone Number	:	408-318-7459
Fax Number	:

Provider Business Practice Location Address
First Line	:	3265 S SEPULVEDA BLVD APT 305
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-5219
Country	:	US
Telephone Number	:	408-318-7459
Fax Number	:

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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Directions to “ MISA PRIEST ” Practice Location

Language	Start Address	Practice Location

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