Healthcare Provider Details

I. General information

NPI: 1972073724
Provider Name (Legal Business Name): JESUS Q FELIX JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
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

13529 COBBLESTONE LN
WESTMINSTER CA
92683-2375
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-6596
  • Fax:
Mailing address:
  • Phone: 253-267-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA49520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: