Individual
EDGAR NEPOMUCENO MALBAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
8721 BALD EAGLE DR, EASTVALE, CA 92880-1097
(949) 836-2018
Mailing address
8721 BALD EAGLE DR, EASTVALE, CA 92880-1097
(949) 836-2018
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
PT24015
CA
2251X0800X
Orthopedic Physical Therapist
Primary
PT24015
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT240150
BLUE SHIELD
CA
Enumeration date
08/15/2006
Last updated
08/22/2014
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