Individual
MS. FAITH INTERVALO VILLANUEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
100 DIAMOND RANCH RD, POMONA, CA 91766-4723
(909) 397-4715
Mailing address
9017 SYCAMORE AVE UNIT 212, MONTCLAIR, CA 91763-5609
(714) 290-5749
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
06/21/2017
Last updated
06/21/2017
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