Healthcare Provider Details

I. General information

NPI: 1306166293
Provider Name (Legal Business Name): MA. TERESITA AQUINO BORIO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 VINE ST APT. C
GLENDALE CA
91204-1517
US

IV. Provider business mailing address

431 VINE ST APT. C
GLENDALE CA
91204-1517
US

V. Phone/Fax

Practice location:
  • Phone: 213-458-0426
  • Fax: 818-507-0224
Mailing address:
  • Phone: 213-458-0426
  • Fax: 818-507-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT8769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: