Healthcare Provider Details

I. General information

NPI: 1861448995
Provider Name (Legal Business Name): MARI MAGNOLIA JASMIN BESINGA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14513 RIO BLANCO RD
LA MIRADA CA
90638-4430
US

IV. Provider business mailing address

14513 RIO BLANCO RD
LA MIRADA CA
90638-4430
US

V. Phone/Fax

Practice location:
  • Phone: 562-881-4431
  • Fax: 714-221-2255
Mailing address:
  • Phone: 562-881-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: