Individual
MS. ANTOINETTE EVANGELISTA COLCOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3417 KENNELWORTH LN, BONITA, CA 91902-1509
(619) 746-1611
Mailing address
3417 KENNELWORTH LN, BONITA, CA 91902-1509
(619) 746-1611
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT9803
CA
Other
Enumeration date
09/25/2014
Last updated
09/25/2014
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