Provider Demographics
NPI:1659724490
Name:ARIAS, INGRID AZUCENA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:AZUCENA
Last Name:ARIAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15410 LORETTA DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1536
Mailing Address - Country:US
Mailing Address - Phone:562-266-7160
Mailing Address - Fax:
Practice Address - Street 1:2700 N MAIN ST STE 945
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6678
Practice Address - Country:US
Practice Address - Phone:714-542-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist