Provider Demographics
NPI:1295383438
Name:PAREDES, CRISTIAN W (CA LIC # 17461)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:W
Last Name:PAREDES
Suffix:
Gender:M
Credentials:CA LIC # 17461
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 PEARCE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2750
Mailing Address - Country:US
Mailing Address - Phone:562-208-4034
Mailing Address - Fax:
Practice Address - Street 1:7772 CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3003
Practice Address - Country:US
Practice Address - Phone:714-663-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist