Provider Demographics
NPI:1326344029
Name:GOPALAN, SOWMYA NARAYANAN (MSC SPEECH & HEARING)
Entity Type:Individual
Prefix:MR
First Name:SOWMYA
Middle Name:NARAYANAN
Last Name:GOPALAN
Suffix:
Gender:M
Credentials:MSC SPEECH & HEARING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 POINSETTIA CIR
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-4918
Mailing Address - Country:US
Mailing Address - Phone:909-588-8485
Mailing Address - Fax:
Practice Address - Street 1:1092 POINSETTIA CIR
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-4918
Practice Address - Country:US
Practice Address - Phone:909-588-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP18155OtherCALIFORNIA STATE SPEECH PATHOLOGIST LICENSE