Provider Demographics
NPI:1467004184
Name:MACATULA, AIREEN (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:AIREEN
Middle Name:
Last Name:MACATULA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 N BANNA AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2532
Mailing Address - Country:US
Mailing Address - Phone:626-825-5955
Mailing Address - Fax:
Practice Address - Street 1:812 N BANNA AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2532
Practice Address - Country:US
Practice Address - Phone:626-825-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist