Individual
EMELYN BERNARDO PENALOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
800 S HAM LN, LODI, CA 95242-3543
(209) 368-7141
Mailing address
8887 SERRAVILLA WAY, ELK GROVE, CA 95758-6338
(989) 254-0669
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA10004
CA
Other
Enumeration date
08/26/2017
Last updated
08/26/2017
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