Provider Demographics
NPI:1245620384
Name:THRIVE AND SHINE SPEECH THERAPY, INC.
Entity Type:Organization
Organization Name:THRIVE AND SHINE SPEECH THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:310-866-9958
Mailing Address - Street 1:PO BOX 3215
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-0215
Mailing Address - Country:US
Mailing Address - Phone:310-954-9614
Mailing Address - Fax:310-526-6561
Practice Address - Street 1:292 S LA CIENEGA BLVD
Practice Address - Street 2:#250
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3330
Practice Address - Country:US
Practice Address - Phone:310-954-9614
Practice Address - Fax:310-526-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty