Provider Demographics
NPI:1932598703
Name:PAREDES, JUAN GUSTAVO JR (SLPA)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:GUSTAVO
Last Name:PAREDES
Suffix:JR
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 DEERPARK DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1514
Mailing Address - Country:US
Mailing Address - Phone:562-756-3864
Mailing Address - Fax:
Practice Address - Street 1:2255 DEERPARK DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1514
Practice Address - Country:US
Practice Address - Phone:562-756-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23362355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant