Provider Demographics
NPI:1770948283
Name:FIVE OAKS SPEECH THERAPY SERVICES PC
Entity type:Organization
Organization Name:FIVE OAKS SPEECH THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:909-824-2899
Mailing Address - Street 1:22365 BARTON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5015
Mailing Address - Country:US
Mailing Address - Phone:909-824-2899
Mailing Address - Fax:909-687-2326
Practice Address - Street 1:22365 BARTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5015
Practice Address - Country:US
Practice Address - Phone:909-824-2899
Practice Address - Fax:909-687-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10442261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech