Individual
BERYL AVILA FOGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
3000 TENNYSON PL, HERMOSA BEACH, CA 90254-2262
(310) 480-1862
Mailing address
3000 TENNYSON PL, HERMOSA BEACH, CA 90254-2262
(310) 480-1862
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10956
CA
Other
Enumeration date
10/12/2020
Last updated
10/12/2020
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