Provider Demographics
NPI:1689374175
Name:KATHRAMALLA, SOLOMONRAJ SUNIL KUMAR (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SOLOMONRAJ SUNIL
Middle Name:KUMAR
Last Name:KATHRAMALLA
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGIST
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35410 DEL REY
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:757 BEACON
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0857
Practice Address - Country:US
Practice Address - Phone:562-650-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist