Provider Demographics
NPI:1568708949
Name:PILLAI, SANGEETHA
Entity Type:Individual
Prefix:
First Name:SANGEETHA
Middle Name:
Last Name:PILLAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 WILSHIRE BLVD
Mailing Address - Street 2:STE.300A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1906 W GARVEY AVE S
Practice Address - Street 2:STE.102
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2652
Practice Address - Country:US
Practice Address - Phone:626-338-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 17475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist