MEDICARE: PREMA POLIT 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
1	235Z00000X	Speech-Language Pathologist	SP33247	CA

General Provider Information

NPI Number	:	1871444042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREMA POLIT CCC-SLP

Provider Business Mailing Address
First Line	:	1930B CHESTNUT ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-2818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4314 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4716
Country	:	US
Telephone Number	:	510-654-6377
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “ PREMA POLIT CCC-SLP” Practice Location

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