Provider Demographics
NPI:1437535242
Name:PENTUCCI, MARIA LAURA
Entity type:Individual
Prefix:
First Name:MARIA LAURA
Middle Name:
Last Name:PENTUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA LAURA
Other - Middle Name:
Other - Last Name:PENTUCCI DE FILIPPINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 W HERMITAGE LN
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702
Mailing Address - Country:US
Mailing Address - Phone:626-759-1903
Mailing Address - Fax:
Practice Address - Street 1:706 N DIAMOND BAR BLVD # B
Practice Address - Street 2:SUITE B
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765
Practice Address - Country:US
Practice Address - Phone:909-396-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist