Provider Demographics
NPI:1558186221
Name:BRIGHTPATH PEDIATRIC SPEECH THERAPY, P.C.
Entity type:Organization
Organization Name:BRIGHTPATH PEDIATRIC SPEECH THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CINTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACINTO TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:909-637-1738
Mailing Address - Street 1:7922 DAY CREEK BLVD APT 4213
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8589
Mailing Address - Country:US
Mailing Address - Phone:909-637-1738
Mailing Address - Fax:
Practice Address - Street 1:9377 HAVEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5340
Practice Address - Country:US
Practice Address - Phone:909-206-4205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty