Healthcare Provider Details

I. General information

NPI: 1659227817
Provider Name (Legal Business Name): RICHELLE MOJICA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 S BREA CANYON RD STE E
DIAMOND BAR CA
91765-3481
US

IV. Provider business mailing address

8304 SAN LUIS POTOSI PL
PICO RIVERA CA
90660-2210
US

V. Phone/Fax

Practice location:
  • Phone: 909-258-9292
  • Fax:
Mailing address:
  • Phone: 626-315-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: