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NPI Code Detail

MEDICARE: STEPHANIE BOAYES OBUSAN

MEDICARE: STEPHANIE BOAYES OBUSAN
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
12355S0801XSpeech-Language AssistantSPA 3418CA
2235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1447704341
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE BOAYES OBUSAN
Provider Business Mailing Address
First Line : 1415 257TH ST APT 9
Second Line :
City : HARBOR CITY
State : CA
Zip : 90710-2761
Country : US
Telephone Number : 310-529-0194
Fax Number :
Provider Business Practice Location Address
First Line : 3521 LOMITA BLVD STE 201
Second Line :
City : TORRANCE
State : CA
Zip : 90505-5040
Country : US
Telephone Number : 310-856-8528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2016
Last Update Date : 07/03/2019

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Directions to “ STEPHANIE BOAYES OBUSAN ” Practice Location

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