Provider Demographics
NPI:1154663805
Name:RESTON-PARHAM, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:RESTON-PARHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:AKEMI
Other - Last Name:RESTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1499 HUNTINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5444
Mailing Address - Country:US
Mailing Address - Phone:626-403-4370
Mailing Address - Fax:626-403-4260
Practice Address - Street 1:1499 HUNTINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5444
Practice Address - Country:US
Practice Address - Phone:626-403-4370
Practice Address - Fax:626-403-4260
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9897103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical