Provider Demographics
NPI:1962619783
Name:GAVINA, CARMEN E (SPEECH ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:E
Last Name:GAVINA
Suffix:
Gender:F
Credentials:SPEECH ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 LANDIS ST APT 203
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4801
Mailing Address - Country:US
Mailing Address - Phone:818-972-9413
Mailing Address - Fax:
Practice Address - Street 1:3537 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3211
Practice Address - Country:US
Practice Address - Phone:626-444-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2732355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant