Individual
CARLOS FABIAN ONTIVEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7826 BROADWAY, LEMON GROVE, CA 91945-1801
(619) 876-4420
Mailing address
9109 SAN ANDRES ST, SPRING VALLEY, CA 91977-5845
(619) 517-6848
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT305326
CA
Other
Enumeration date
02/02/2024
Last updated
02/02/2024
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