Provider Demographics
NPI:1346740941
Name:B.S.P. PROFESSIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:B.S.P. PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD MSCCCC-A/SLP
Authorized Official - Phone:714-956-5575
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 APT OR
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAUD1424231H00000X
CASLP8464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty