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NPI Code Detail

MEDICARE: REISHA GOLDEN CCC-SLP

MEDICARE: REISHA GOLDEN 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
1235Z00000XSpeech-Language Pathologist23664CA

General Provider Information

NPI Number : 1306298773
Entity Type Code : Organization
Provider Name (Legal Business Name) : REISHA GOLDEN CCC-SLP
Provider Business Mailing Address
First Line : 4401 ATLANTIC AVE STE 200
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-2264
Country : US
Telephone Number : 714-614-1316
Fax Number :
Provider Business Practice Location Address
First Line : 4401 ATLANTIC AVE STE 200
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-2264
Country : US
Telephone Number : 714-614-1316
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MS. REISHA GOLDEN
Credential : SLP
Telephone Number : 714-614-1316
Provider Enumeration Date : 07/08/2016
Last Update Date : 03/17/2018

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Directions to “REISHA GOLDEN CCC-SLP ” Practice Location

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