Individual
IVANOVA GUILLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
9089 CLAIREMONT MESA BLVD, SUITE 200, SAN DIEGO, CA 92123-1234
(800) 787-6787
Mailing address
3541 VALLEY RD APT 3, BONITA, CA 91902-4161
(626) 261-3941
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT10270
CA
Other
Enumeration date
01/30/2015
Last updated
01/30/2015
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