Provider Demographics
NPI:1942864616
Name:LLAMAS, DANIEL VEGA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:VEGA
Last Name:LLAMAS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3943
Mailing Address - Country:US
Mailing Address - Phone:760-996-1448
Mailing Address - Fax:
Practice Address - Street 1:688 SANDALWOOD DR
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3943
Practice Address - Country:US
Practice Address - Phone:760-996-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist