Provider Demographics
NPI:1447454749
Name:CHURAN, CYNTHIA (SLP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CHURAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MENAUL BLVD NE
Mailing Address - Street 2:CENTER FOR DEVELOPMENT AND DISABILITY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1851
Mailing Address - Country:US
Mailing Address - Phone:505-272-3268
Mailing Address - Fax:
Practice Address - Street 1:2300 MENAUL BLVD NE
Practice Address - Street 2:CENTER FOR DEVELOPMENT AND DISABILITY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1851
Practice Address - Country:US
Practice Address - Phone:505-272-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM63470730Medicaid