Basic Information
Provider Information | |||||||||
NPI: | 1184776262 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ACEVEDO-FREY | ||||||||
FirstName: | SYLVIA | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5555 GARDEN GROVE BLVD STE 200 | ||||||||
Address2: |   | ||||||||
City: | WESTMINSTER | ||||||||
State: | CA | ||||||||
PostalCode: | 926838234 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7148985732 | ||||||||
FaxNumber: | 7149014058 | ||||||||
Practice Location | |||||||||
Address1: | 28071 BRADLEY RD | ||||||||
Address2: |   | ||||||||
City: | SUN CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 925862207 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9518214911 | ||||||||
FaxNumber: | 9516798259 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/17/2007 | ||||||||
LastUpdateDate: | 03/19/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/19/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AU661 | CA | N |   | Speech, Language and Hearing Service Providers | Audiologist |   | 237600000X | AU661 | CA | Y |   | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |   |
ID Information
ID | Type | State | Issuer | Description | AU0006610 | 05 | CA |   | MEDICAID |