Provider Demographics
NPI:1558677179
Name:LOPEZ-GOSTICH, CINTHIA M
Entity Type:Individual
Prefix:MS
First Name:CINTHIA
Middle Name:M
Last Name:LOPEZ-GOSTICH
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:PO BOX 2975
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-2975
Mailing Address - Country:US
Mailing Address - Phone:760-352-1628
Mailing Address - Fax:760-352-1628
Practice Address - Street 1:2366 18TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-6176
Practice Address - Country:US
Practice Address - Phone:760-352-1628
Practice Address - Fax:760-352-1628
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 13118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12075049OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
CASP 13118OtherSTATE OF CALIFORNIA