Provider Demographics
NPI:1760183008
Name:VU, TOM (MS)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:VU
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31765 DOVE CT
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-7209
Mailing Address - Country:US
Mailing Address - Phone:951-867-1075
Mailing Address - Fax:
Practice Address - Street 1:1906 ORANGE TREE LN STE 230
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4511
Practice Address - Country:US
Practice Address - Phone:909-235-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist