Basic Information
| Provider Information | |||||||||
| NPI: | 1336270644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPISTRANO | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ELANI | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SPEECH PATHOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1046 GREYCLOUD LN | ||||||||
| Address2: | |||||||||
| City: | DIAMOND BAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917654219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096120585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 830 S. CITRUS AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | AZUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263396514 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 9690 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.