Provider Demographics
NPI:1073235214
Name:GHAZALEH, RIDA
Entity Type:Individual
Prefix:
First Name:RIDA
Middle Name:
Last Name:GHAZALEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3790 PLANTATION CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4473
Mailing Address - Country:US
Mailing Address - Phone:909-945-7449
Mailing Address - Fax:
Practice Address - Street 1:3790 PLANTATION CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4473
Practice Address - Country:US
Practice Address - Phone:909-945-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist