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Organization

EXTENSIVE THERAPY CONNECTION AND SOLUTION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SAWMICK DUTTA MS (SPEECH AND LANGUAGE PATHOLOGIST)
(951) 332-7832
Entity
Organization

Contact information

Practice address
1618 FOX GLEN DR, DIAMOND BAR, CA 91765-2929
(951) 332-7832
Mailing address
1618 FOX GLEN DR, DIAMOND BAR, CA 91765-2929
(951) 332-7832

Taxonomy

Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
14361
CA
251300000X
Local Education Agency (LEA)
14383
CA

Other

Enumeration date
05/24/2011
Last updated
05/24/2011
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