Provider Demographics
NPI:1356888655
Name:OBEMBE, CLARISSA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:OBEMBE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:CALZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6076 BRISTOL PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6600
Mailing Address - Country:US
Mailing Address - Phone:310-642-7700
Mailing Address - Fax:310-645-0394
Practice Address - Street 1:633 W 5TH ST OFC 2876B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90071-2005
Practice Address - Country:US
Practice Address - Phone:512-399-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24766235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist