Provider Demographics
NPI:1558937268
Name:PURUSHOTHAMAN, THIRUNAVUKKARASU (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:THIRUNAVUKKARASU
Middle Name:
Last Name:PURUSHOTHAMAN
Suffix:
Gender:M
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18316 SEINE AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5743
Mailing Address - Country:US
Mailing Address - Phone:909-560-7552
Mailing Address - Fax:
Practice Address - Street 1:18316 SEINE AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5743
Practice Address - Country:US
Practice Address - Phone:909-560-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP18027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist