Provider Demographics
NPI:1508424706
Name:CAVALEA, NICOLE (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:CAVALEA
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5948 VISTA LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-6562
Mailing Address - Country:US
Mailing Address - Phone:408-515-4037
Mailing Address - Fax:
Practice Address - Street 1:5948 VISTA LOOP
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-6562
Practice Address - Country:US
Practice Address - Phone:408-515-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80-0780229OtherTAX ID NUMBER