MEDICARE: MRS. DOREEN MARIE LA PORTE

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	SP9870	CA

General Provider Information

NPI Number	:	1184866634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOREEN MARIE LA PORTE

Provider Business Mailing Address
First Line	:	2923 CLAREMORE LN
Second Line	:	#40
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1645
Country	:	US
Telephone Number	:	949-573-3559
Fax Number	:	562-439-2232

Provider Business Practice Location Address
First Line	:	5842 E NAPLES PLZ
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5039
Country	:	US
Telephone Number	:	562-439-9539
Fax Number	:	562-439-2232

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

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/30/2009

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