Basic Information
Provider Information
NPI: 1245551605
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHWARTZ
FirstName: ROSA
MiddleName: ANGELA
NamePrefix: MS.
NameSuffix:  
Credential: M.A. CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 625 FAIR OAKS AVE
Address2: SUITE 200
City: SOUTH PASADENA
State: CA
PostalCode: 910302630
CountryCode: US
TelephoneNumber: 3233415580
FaxNumber: 3233408298
Practice Location
Address1: 1111 W 6TH ST
Address2: SUITE 111
City: LOS ANGELES
State: CA
PostalCode: 900171800
CountryCode: US
TelephoneNumber: 3234041027
FaxNumber: 3233408298
Other Information
ProviderEnumerationDate: 06/18/2010
LastUpdateDate: 06/18/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X17650CAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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