Provider Demographics
NPI:1912572140
Name:SHINE BRIGHT SPEECH AND LANGUAGE THERAPY CORP.
Entity Type:Organization
Organization Name:SHINE BRIGHT SPEECH AND LANGUAGE THERAPY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-223-5354
Mailing Address - Street 1:27076 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-3662
Mailing Address - Country:US
Mailing Address - Phone:951-223-5354
Mailing Address - Fax:
Practice Address - Street 1:473 CARNEGIE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:951-223-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHINE BRIGHT NETWORK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty