| Doctor Name: | MR. RADHAKRISHNAN SANJEEVI |
| NPI Number: | 1396158663 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 21645 |
| Business Practice Address: | 706 N Diamond Bar Blvd Suite B2 Diamond Bar, CA - 917651059 |
| Business Phone Number: | 9093968900 |
| Business Fax Number: | 9093969900 |
| Mailing Address: | 706 N Diamond Bar Blvd, Suite B2 DIAMOND BAR |
| State: | CA |
| Postal Code: | 917651059 |
| Phone Number: | 9093968900 |
| Fax Number: | 9093969900 |
| NPI Enumeration Date: | 06/04/2014 |
| NPI Last Update Date: | 06/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 21645 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |