Active NPI
Kenya Gomez-Tydor, M.A. SLP
- Speech-Language Pathologist
- Fullerton, CA
National Provider Identifier
1861943482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 11052
- Practice address
- 680 Langsdorf Dr
Suite 110
Fullerton, CA 92831-3702 - Phone
- (855) 901-7742
- NPI assigned
- Oct 19, 2016
- 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 | 11052 | CA | Primary |
Addresses
Primary practice location
680 Langsdorf Dr
Suite 110
Fullerton, CA 92831-3702
Mailing address
680 Langsdorf Dr
Suite 110
Fullerton, CA 92831-3702
Phone (855) 901-7742
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11052 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1861943482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 LANGSDORF DR",
"address_2": "SUITE 110",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928313702",
"telephone_number": "855-901-7742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 LANGSDORF DR",
"address_2": "SUITE 110",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928313702",
"telephone_number": "855-901-7742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ-TYDOR",
"first_name": "KENYA",
"credential": "M.A. SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-19",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "11052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.