Individual
AUDRENE UNTALAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
13223 BLACK MOUNTAIN RD # 1508, SAN DIEGO, CA 92129-2698
(858) 753-5082
Mailing address
13223 BLACK MOUNTAIN RD, SAN DIEGO, CA 92129-2698
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
38930
CA
Other
Enumeration date
05/21/2025
Last updated
05/21/2025
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