MEDICARE: JANICA PAULINE CLEMENTE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	50501	CA

General Provider Information

NPI Number	:	1598390528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICA PAULINE CLEMENTE PTA

Provider Business Mailing Address
First Line	:	1716 BROCKTON AVE APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3850
Country	:	US
Telephone Number	:	714-425-7272
Fax Number	:

Provider Business Practice Location Address
First Line	:	25768 COVALA COURT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355
Country	:	US
Telephone Number	:	714-425-7272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	12/19/2025

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