Provider Demographics
NPI:1104157817
Name:KALOOR, MANJULA (SLP)
Entity type:Individual
Prefix:
First Name:MANJULA
Middle Name:
Last Name:KALOOR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2816
Mailing Address - Country:US
Mailing Address - Phone:626-451-6864
Mailing Address - Fax:
Practice Address - Street 1:515 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2816
Practice Address - Country:US
Practice Address - Phone:626-451-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2019-12-27
Deactivation Date:2018-04-06
Deactivation Code:
Reactivation Date:2019-12-27
Provider Licenses
StateLicense IDTaxonomies
CA14378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist