Wenna Kae Pasana Requieron, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

33520 Issued in CA

Practice address

27393 Ynez Rd Ste 153
Temecula, CA 92591-4605

Phone

(951) 331-2154

NPI assigned

May 31, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Full Potential Speech Therapy Center, Inc

  • Speech-Language Pathologist
  • Temecula, CA
  • NPI 1548729122
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1255070140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36284 REDBUD LN",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925624382",
            "telephone_number": "951-348-0995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27393 YNEZ RD STE 153",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925914605",
            "telephone_number": "951-331-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REQUIERON",
        "first_name": "WENNA KAE",
        "middle_name": "PASANA",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-31",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "33520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPEECH PATHOLOGIST",
            "identifier": "33520",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wenna@fullpotentialspeech.com",
            "affiliation": "Y",
            "endpointDescription": "Professional E-mail",
            "affiliationName": "Full Potential Speech Therapy Center, Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "27393 Ynez Rd Ste 153",
            "city": "Temecula",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925914605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jemely Alejandra Renteria
• Kassandra Renteria
• Stephani Renteria
• Victoria Bianca Renteria
• Nathan Repasky, MD
• Rescare Hospice Inc
• Dolores Resendiz
• Resiliency Therapy Services, Licensed Clinical Social Worker, Inc.
• Alexandrea Resnick
• Responsible Medical Solutions Corp

• Speech-Language Pathologist in Temecula, CA
• Providers in Temecula, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.