Provider Demographics
NPI:1215368295
Name:MAYBRUCK, IRIS (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:
Last Name:MAYBRUCK
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 PANDORA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5060
Mailing Address - Country:US
Mailing Address - Phone:310-474-0819
Mailing Address - Fax:310-475-2864
Practice Address - Street 1:1920 PANDORA AVE
Practice Address - Street 2:#4
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5060
Practice Address - Country:US
Practice Address - Phone:310-474-0819
Practice Address - Fax:310-475-2864
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2784235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist