Individual
CRISTINA MARIA PROVASOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8009 HULBERT AVE, PLAYA DEL REY, CA 90293-7939
(310) 648-4045
Mailing address
8009 HULBERT AVE, PLAYA DEL REY, CA 90293-7939
(310) 648-4045
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
23872
CA
Other
Enumeration date
03/26/2020
Last updated
03/26/2020
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