Provider Demographics
NPI:1457097230
Name:STRIVE LOGOPEDICS CENTER CORP
Entity Type:Organization
Organization Name:STRIVE LOGOPEDICS CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORETTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:909-567-2035
Mailing Address - Street 1:3068 CHABLIS AVE
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-1046
Mailing Address - Country:US
Mailing Address - Phone:909-567-2035
Mailing Address - Fax:
Practice Address - Street 1:1906 COMMERCENTER E STE 206
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3424
Practice Address - Country:US
Practice Address - Phone:951-906-6535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine