Healthcare Provider Details

I. General information

NPI: 1649669292
Provider Name (Legal Business Name): MARGARET KOMRIJ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 W LA VETA AVE
ORANGE CA
92868-4132
US

IV. Provider business mailing address

11114 BERMUDA ST
CERRITOS CA
90703-1639
US

V. Phone/Fax

Practice location:
  • Phone: 714-978-6800
  • Fax:
Mailing address:
  • Phone: 714-294-4098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 4064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: