Individual
SANAM EJAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
9695 BASE LINE RD, RANCHO CUCAMONGA, CA 91730-1314
(909) 481-0437
Mailing address
6350 SERPENS CT, EASTVALE, CA 91752-7616
(949) 310-9139
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
50639
CA
Other
Enumeration date
09/01/2023
Last updated
09/01/2023
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