Individual
SUSAN MAIS-REQUEJO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
2819 JOSIE AVE, LONG BEACH, CA 90815-1515
(562) 743-3761
(596) 496-3628
Mailing address
2819 JOSIE AVE, LONG BEACH, CA 90815-1515
(562) 743-3761
(596) 496-3628
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT18717
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT181717
LICENSE
CA
Enumeration date
06/13/2007
Last updated
04/30/2014
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