Most Relevant Information
Provider Data
| NPI Number: | 1003206970 |
| Provider Name: | IVANOVA GUILLEN PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | AT10270 |
Most Important Dates
| Enumeration Date: | 01/30/2015 |
| Last Updated: | 01/30/2015 |
Provider Practice Location
9089 CLAIREMONT MESA BLVD
SUITE 200
SAN DIEGO
CA
921231234
Practice Location Phone/Fax
| Phone: | 8007876787 |
| Fax: |
Provider Mailing Location
3541 VALLEY RD APT 3
BONITA
CA
919024161
Provider Mailing Phone/Fax
| Phone: | 6262613941 |
| Fax: |