Individual
GRACE BUMACOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SPEECH PATHOLOGIST
Contact information
Practice address
245 W SIERRA MADRE BLVD, SIERRA MADRE, CA 91024-2355
(626) 822-5992
Mailing address
528 E VERDUGO AVE APT L, BURBANK, CA 91501-2339
(818) 452-8124
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
19239
CA
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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