Individual
MS. ANNICA MABUNGA ASILO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
311 RAY ST, PLEASANTON, CA 94566-6621
(925) 399-5796
(925) 249-5121
Mailing address
311 RAY ST, PLEASANTON, CA 94566-6621
(925) 399-5796
(925) 249-5121
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208610724
SPEECH THERAPY
CA
Enumeration date
09/28/2021
Last updated
09/28/2021
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