Provider Demographics
NPI:1659535268
Name:SHIGETOMI-TOYAMA, SANDRA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SHIGETOMI-TOYAMA
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 1:3300 IRVINE AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3109
Mailing Address - Country:US
Mailing Address - Phone:713-306-1225
Mailing Address - Fax:949-250-9485
Practice Address - Street 1:3300 IRVINE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3109
Practice Address - Country:US
Practice Address - Phone:714-306-1225
Practice Address - Fax:949-250-9485
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP#12262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist