Individual
MALYSSA ROBIN CARLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1235 INDIANA CT STE 107, REDLANDS, CA 92374-4540
(909) 566-3358
(909) 757-6400
Mailing address
410 S CLEMENTINE ST APT 207, ANAHEIM, CA 92805-3855
(562) 361-6884
(909) 757-6400
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
F2088491
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F2088491
—
CA
Enumeration date
08/23/2021
Last updated
09/24/2021
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