Provider Demographics
NPI:1285279968
Name:VITAL, MAE BELENE AALA (MA, SLP)
Entity type:Individual
Prefix:
First Name:MAE BELENE
Middle Name:AALA
Last Name:VITAL
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:MAE BELENE
Other - Middle Name:MANEJA
Other - Last Name:AALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, SLP
Mailing Address - Street 1:3976 S MANITOBA PL
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7934
Mailing Address - Country:US
Mailing Address - Phone:442-274-9970
Mailing Address - Fax:
Practice Address - Street 1:3976 S MANITOBA PL
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7934
Practice Address - Country:US
Practice Address - Phone:442-274-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-17
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist