Healthcare Provider Details

I. General information

NPI: 1609319276
Provider Name (Legal Business Name): RESHMABANU MOMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N STATE COLLEGE BLVD STE G
ANAHEIM CA
92806-2932
US

IV. Provider business mailing address

2841 E LINCOLN AVE APT 231
ANAHEIM CA
92806-4022
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-6596
  • Fax:
Mailing address:
  • Phone: 619-200-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number48361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: