Provider Demographics
NPI:1265711998
Name:DYNAMIC THERAPY SOLUTIONS AND DYSLEXIA CENTER, PC
Entity type:Organization
Organization Name:DYNAMIC THERAPY SOLUTIONS AND DYSLEXIA CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:661-274-8454
Mailing Address - Street 1:190 SIERRA COURT
Mailing Address - Street 2:STE C-10
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550
Mailing Address - Country:US
Mailing Address - Phone:661-274-8454
Mailing Address - Fax:661-274-7614
Practice Address - Street 1:190 SIERRA COURT
Practice Address - Street 2:STE C-10
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-274-8454
Practice Address - Fax:661-274-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP11463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty