Individual provider Active NPI

Avinash Mirle Chandrashekar

  • Speech-Language Pathologist
  • Eastvale, CA
National Provider Identifier
1477930949
Registry record updated May 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP 22570 Issued in CA
Practice address
5725 Darbreak Dr, Apt C
Eastvale, CA 91752
Phone
(209) 322-6092
NPI assigned
May 4, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP 22570 CA Primary

Addresses

Primary practice location

5725 Darbreak Dr, Apt C
Eastvale, CA 91752

Mailing address

5725 Daybreak Dr Apt C
Eastvale, CA 91752-6687
Phone (209) 322-6092

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
SP 22570CAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430697600000",
    "number": "1477930949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5725 DAYBREAK DR APT C",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "917526687",
            "telephone_number": "209-322-6092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5725 DARBREAK DR, APT C",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "91752",
            "telephone_number": "209-322-6092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRLE CHANDRASHEKAR",
        "first_name": "AVINASH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-04",
        "last_updated": "2015-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "SP 22570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastvale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; 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.