Provider Demographics
NPI:1043465438
Name:PANCHAL, BELLA (AUD MSCCCC-A/SLP)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:AUD MSCCCC-A/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3774
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-3774
Mailing Address - Country:US
Mailing Address - Phone:714-956-5575
Mailing Address - Fax:714-956-5575
Practice Address - Street 1:1197 N ARBOR ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2021
Practice Address - Country:US
Practice Address - Phone:714-956-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1424231H00000X
CASLP8464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist