Provider Demographics
NPI:1891209425
Name:BLATZ, REBECCA LEIGH (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEIGH
Last Name:BLATZ
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 HOTSPRING DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-6756
Mailing Address - Country:US
Mailing Address - Phone:951-264-4226
Mailing Address - Fax:
Practice Address - Street 1:785 YORKSHIRE WAY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3143
Practice Address - Country:US
Practice Address - Phone:951-264-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty