MEDICARE: AURAVISTA SPEECH THERAPY - PC

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

General Provider Information

NPI Number	:	1922955913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURAVISTA SPEECH THERAPY - PC

Provider Business Mailing Address
First Line	:	4625 STARK AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-3851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4625 STARK AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-3851
Country	:	US
Telephone Number	:	818-288-2525
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	SHIRIN HAKIMI
Credential	:	SLP
Telephone Number	:	818-288-2525

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “AURAVISTA SPEECH THERAPY - PC ” Practice Location

Language	Start Address	Practice Location

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