Provider Demographics
NPI:1669192282
Name:BURCIAGA SPEECH PATHOLOGY, INC.
Entity type:Organization
Organization Name:BURCIAGA SPEECH PATHOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:909-235-9875
Mailing Address - Street 1:2920 INLAND EMPIRE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5565
Mailing Address - Country:US
Mailing Address - Phone:909-235-9875
Mailing Address - Fax:909-614-4922
Practice Address - Street 1:2920 INLAND EMPIRE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5565
Practice Address - Country:US
Practice Address - Phone:909-235-9875
Practice Address - Fax:909-614-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty