Active NPI
Iris Maybruck, SPEECH PATHOLOGIST
- Speech-Language Pathologist
- Los Angeles, CA
National Provider Identifier
1215368295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2784
- Practice address
- 1920 Pandora Ave
#4
Los Angeles, CA 90025-5060 - Phone
- (310) 474-0819
- Fax
- (310) 475-2864
- NPI assigned
- Dec 2, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2784 | CA | Primary |
Addresses
Primary practice location
1920 Pandora Ave
#4
Los Angeles, CA 90025-5060
Mailing address
1920 Pandora Ave
Los Angeles, CA 90025-5060
Phone (310) 474-0819
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2784 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385942400000",
"number": "1215368295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1920 PANDORA AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900255060",
"telephone_number": "310-474-0819",
"fax_number": "310-475-2864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 PANDORA AVE",
"address_2": "#4",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900255060",
"telephone_number": "310-474-0819",
"fax_number": "310-475-2864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYBRUCK",
"first_name": "IRIS",
"name_prefix": "Dr.",
"credential": "SPEECH PATHOLOGIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-02",
"last_updated": "2013-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "2784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.