Provider Demographics
NPI:1790083749
Name:TBNI
Entity Type:Organization
Organization Name:TBNI
Other - Org Name:THERAPRISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:DI GIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-989-6474
Mailing Address - Street 1:3702 ROADRUNNER DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-1002
Mailing Address - Country:US
Mailing Address - Phone:714-989-6474
Mailing Address - Fax:714-200-0234
Practice Address - Street 1:3702 ROADRUNNER DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92823-1002
Practice Address - Country:US
Practice Address - Phone:714-989-6474
Practice Address - Fax:714-200-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty