Active NPI
Anna Broderick
- Speech-Language Pathologist
- Santa Ana, CA
National Provider Identifier
1245651975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 18734
- Practice address
- 1570 E 17TH St
Santa Ana, CA 92705-8502 - Phone
- (714) 834-1111
- Fax
- (714) 972-0454
- NPI assigned
- Dec 24, 2013
- Sex
- Female
- Sole proprietor
- No
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 | 18734 | CA | Primary |
Addresses
Primary practice location
1570 E 17TH St
Santa Ana, CA 92705-8502
Mailing address
6076 Bristol Pkwy Ste 105
Culver City, CA 90230-6600
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 |
|---|---|---|---|
| 18734 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387843200000",
"number": "1245651975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6076 BRISTOL PKWY STE 105",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902306600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1570 E 17TH ST",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927058502",
"telephone_number": "714-834-1111",
"fax_number": "714-972-0454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERICK",
"first_name": "ANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-24",
"last_updated": "2013-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "18734",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 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.