Individual
MRS. MARY ANNE CODILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4301 CAROLINE CT, RIVERSIDE, CA 92506-2902
(951) 683-7111
Mailing address
6681 TANZANITE ST, JURUPA VALLEY, CA 91752-4461
(951) 743-4788
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
719842
CA
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
16295
CA
Other
Enumeration date
09/16/2019
Last updated
09/16/2019
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