Individual
FAIRY ANCHETA EDADES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
10400 ARROW RTE APT V5, RANCHO CUCAMONGA, CA 91730-4782
(909) 948-0879
Mailing address
10400 ARROW RTE APT V5, RANCHO CUCAMONGA, CA 91730-4782
(909) 948-0879
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT8356
CA
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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