Provider Demographics
NPI:1538773718
Name:PARHAM-CRUZADO, GABRIELLA SOLINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:SOLINA
Last Name:PARHAM-CRUZADO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:GABRIELLA
Other - Middle Name:
Other - Last Name:PARHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3879 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3333
Mailing Address - Country:US
Mailing Address - Phone:787-506-4920
Mailing Address - Fax:
Practice Address - Street 1:258B LAGUNA HONDA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1409
Practice Address - Country:US
Practice Address - Phone:415-702-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30303235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist