Individual provider Active NPI

Gloria Omolafe, SLPA

  • Speech-Language Assistant
  • San Bernardino, CA
National Provider Identifier
1376305201
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language AssistantTaxonomy code 2355S0801X
License
6359 Issued in CA
Practice address
301 E Vanderbilt Way Ste 100
San Bernardino, CA 92408-3556
Phone
(909) 567-2661
NPI assigned
Jan 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Assistant 2355S0801X 6359 CA Primary

Addresses

Primary practice location

301 E Vanderbilt Way Ste 100
San Bernardino, CA 92408-3556

Mailing address

4959 Palo Verde St Ste 109C
Montclair, CA 91763-2358
Phone (909) 971-3092

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

LicenseStateTypeSpecialty
6359CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Rapha Physical Therapy, Inc CurrentSince Jan 28, 2024 Accepting new patients
Rapha Rehabilities PastSince Jan 28, 2024 Accepting new patients
Ali H. Mesiwala, M.D., a Medical Corporation PastSince Jan 28, 2024 Accepting new patients

Locations

4959 Palo Verde St
Ste 109C
Montclair, CA 91763
Phone (909) 971-3092

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1706140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1376305201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4959 PALO VERDE ST STE 109C",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632358",
            "telephone_number": "909-971-3092",
            "fax_number": "909-971-3261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E VANDERBILT WAY STE 100",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083556",
            "telephone_number": "909-567-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOLAFE",
        "first_name": "GLORIA",
        "credential": "SLPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "6359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.