=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528905627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GANESH RAJAGOPALAN NAIR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2026
-----------------------------------------------------
Last Update Date | 04/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 PUENTE AVE
-----------------------------------------------------
City | BALDWIN PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91706-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-960-5431
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6883 CHARLOMA ST
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91701-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-450-3427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 16407
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------