Basic Information
| Provider Information | |||||||||
| NPI: | 1952712655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TUSTIN SPEECH THERAPY INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 661 W 1ST ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148382853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 661 W 1ST ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927802939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148382853 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2014 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | SANTOYO | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7143313749 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | C.C.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | SP12299 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.