Provider Demographics
NPI:1346421740
Name:NUPUR TARA SPEECH LANGUAGE PATHOLOGY, INC
Entity Type:Organization
Organization Name:NUPUR TARA SPEECH LANGUAGE PATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NUPUR
Authorized Official - Middle Name:
Authorized Official - Last Name:THUKRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-254-9900
Mailing Address - Street 1:995 MONTAGUE EXPY
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6851
Mailing Address - Country:US
Mailing Address - Phone:408-254-9900
Mailing Address - Fax:408-258-2175
Practice Address - Street 1:995 MONTAGUE EXPY
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6851
Practice Address - Country:US
Practice Address - Phone:408-254-9900
Practice Address - Fax:408-258-2175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP9830OtherSTATE LIC #