Provider Demographics
NPI:1366730657
Name:BRIGHT STAR
Entity type:Organization
Organization Name:BRIGHT STAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-730-7700
Mailing Address - Street 1:17291 IRVINE BLVD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2941
Mailing Address - Country:US
Mailing Address - Phone:714-730-7700
Mailing Address - Fax:714-730-7766
Practice Address - Street 1:17291 IRVINE BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2941
Practice Address - Country:US
Practice Address - Phone:714-730-7700
Practice Address - Fax:714-730-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 10738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty