Provider Demographics
NPI:1275876674
Name:REZAPOOR, NEDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:REZAPOOR
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8544 BURTON WAY
Mailing Address - Street 2:305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3385
Mailing Address - Country:US
Mailing Address - Phone:310-866-9958
Mailing Address - Fax:
Practice Address - Street 1:8544 BURTON WAY
Practice Address - Street 2:305
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3385
Practice Address - Country:US
Practice Address - Phone:310-866-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist