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Organization
PROVIDENCE SPEECH & HEARING CENTER
Active
Organization
PROVIDENCE SPEECH & HEARING CENTER
Active
Other names
Providence Speech and Hearing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAM ELQURA (CONTRACT MANAGER)
(714) 509-3000
Entity
Organization
Contact information
Practice address
1301 W PROVIDENCE AVE, ORANGE, CA 92868-3808
(714) 639-4990
(714) 744-3841
Mailing address
1201 W LA VETA AVE, ORANGE, CA 92868-4203
(714) 509-3000
(714) 744-3841
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
231H00000X
Audiologist
—
CA
235Z00000X
Speech-Language Pathologist
Primary
—
CA
237700000X
Hearing Instrument Specialist
—
CA
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GAU000910
—
CA
05
—
GSP000640
—
CA
01
—
ZZZ01182Z
BLUE SHIELD SPEECH
CA
01
—
ZZZ02320Z
BLUE SHIELD AUDIO
CA
01
—
ZZZ05424Z
BLUE SHIELD OT
CA
01
—
ZZZ43525Z
BLUE SHIELD HEARING AID
CA
Enumeration date
04/24/2006
Last updated
10/14/2022
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