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General NPI Number Information
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NPI Number | 1093459091
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Entity Type | Individual
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Provider Name | ADRIANA KRYSTAL GORDO SLP
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Gender | Female
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 7430 W COMMERCIAL BLVD
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City | LAUDERHILL
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State | FL
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Zip | 33319-2130
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Country | US
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Telephone | 954-756-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 653 NW 89TH AVE
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City | PLANTATION
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State | FL
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Zip | 33324-6107
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Country | US
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Telephone | 939-475-7230
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SZ10592.
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License Number State | FL
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