Healthcare Provider Details

I. General information

NPI: 1649796210
Provider Name (Legal Business Name): RAYMUND DIAZ PARPANA JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N STATE COLLEGE BLVD
ANAHEIM CA
92806-2913
US

IV. Provider business mailing address

20 LEGACY WAY
RANCHO SANTA MARGARITA CA
92688-5566
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-6596
  • Fax:
Mailing address:
  • Phone: 949-302-7808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number48802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: