Provider Demographics
NPI:1619698941
Name:MANUEL SPEARS, DIANA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MANUEL SPEARS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:MANUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:27901 CAMINO SANTO DOMINGO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3323
Mailing Address - Country:US
Mailing Address - Phone:310-213-6223
Mailing Address - Fax:
Practice Address - Street 1:1031 AVENIDA PICO STE 201
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6356
Practice Address - Country:US
Practice Address - Phone:949-388-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACC6741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist