Provider Demographics
NPI:1477944379
Name:BURAGOHAIN, RITUPORNA
Entity Type:Individual
Prefix:MR
First Name:RITUPORNA
Middle Name:
Last Name:BURAGOHAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 COZUMEL ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5634
Mailing Address - Country:US
Mailing Address - Phone:714-399-5819
Mailing Address - Fax:
Practice Address - Street 1:11650 COZUMEL ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5634
Practice Address - Country:US
Practice Address - Phone:714-399-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist