Organization
FULL POTENTIAL SPEECH THERAPY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA GISONDA MS CCC SLP (PRESIDENT)
(949) 606-6487
Entity
Organization
Contact information
Practice address
27393 YNEZ RD STE 153, TEMECULA, CA 92591-4605
(951) 331-2154
Mailing address
44881 TROTSDALE DR, TEMECULA, CA 92592-5874
(951) 331-2154
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578049094
NPI TYPE 1
CA
Enumeration date
03/13/2019
Last updated
08/30/2022
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