Provider Demographics
NPI:1366934473
Name:FIALLOS, ANGELICA (SLP-CCC)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:FIALLOS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10152 ORO VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-3238
Mailing Address - Country:US
Mailing Address - Phone:323-533-1115
Mailing Address - Fax:
Practice Address - Street 1:10152 ORO VISTA AVE
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-3238
Practice Address - Country:US
Practice Address - Phone:323-533-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist