Basic Information
| Provider Information | |||||||||
| NPI: | 1396185385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SASTIEL | ||||||||
| FirstName: | SHIRLEY | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 LINCOLN WAY | ||||||||
| Address2: | APT.302 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941222369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185186666 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4221 WILSHIRE BLVD | ||||||||
| Address2: | STE.300 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900103512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238661880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2013 | ||||||||
| LastUpdateDate: | 07/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 6887 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.