Provider Demographics
NPI:1124165121
Name:ROEL'S PEDIATRIC DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:ROEL'S PEDIATRIC DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-441-4445
Mailing Address - Street 1:1151 EL CENTRO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5721
Mailing Address - Country:US
Mailing Address - Phone:626-441-4445
Mailing Address - Fax:626-441-4695
Practice Address - Street 1:1151 EL CENTRO ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5721
Practice Address - Country:US
Practice Address - Phone:626-441-4445
Practice Address - Fax:626-441-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty