Individual
CARINE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 N LAKE AVE STE 201, PASADENA, CA 91101-5120
(626) 568-9115
Mailing address
2825 ONYX WAY, WEST COVINA, CA 91792-2773
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33865
LICENSE#
CA
Enumeration date
08/22/2007
Last updated
08/22/2007
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