Provider Demographics
NPI:1124710736
Name:NERI, KARLA PATRICIA CRUZ (MS SLP)
Entity type:Individual
Prefix:
First Name:KARLA PATRICIA
Middle Name:CRUZ
Last Name:NERI
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4081 GREEN AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3410
Mailing Address - Country:US
Mailing Address - Phone:760-265-3402
Mailing Address - Fax:
Practice Address - Street 1:500 W CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3036
Practice Address - Country:US
Practice Address - Phone:714-529-5022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29200OtherSPEECH PATHOLOGIST LICENSE