Provider Demographics
NPI:1316492895
Name:AFFATATI, STARLA (MS-CCC, SLP)
Entity type:Individual
Prefix:
First Name:STARLA
Middle Name:
Last Name:AFFATATI
Suffix:
Gender:F
Credentials:MS-CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31577 CANYON ESTATES DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0473
Mailing Address - Country:US
Mailing Address - Phone:951-226-4314
Mailing Address - Fax:
Practice Address - Street 1:31577 CANYON ESTATES DR STE 230
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0473
Practice Address - Country:US
Practice Address - Phone:951-226-4314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist