Provider Demographics
NPI:1376853853
Name:GELLER-SMITH, NAIDA LYNNE (SLP)
Entity type:Individual
Prefix:
First Name:NAIDA
Middle Name:LYNNE
Last Name:GELLER-SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3467
Mailing Address - Country:US
Mailing Address - Phone:909-890-9030
Mailing Address - Fax:909-890-4393
Practice Address - Street 1:802 MAGNOLIA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3104
Practice Address - Country:US
Practice Address - Phone:951-340-0070
Practice Address - Fax:951-340-9188
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA112345Medicare PIN