Healthcare Provider Details

I. General information

NPI: 1659034148
Provider Name (Legal Business Name): EMILIA ALTEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILIA BUDI

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S HUDSON AVE
PASADENA CA
91101-2606
US

IV. Provider business mailing address

111 S HUDSON AVE
PASADENA CA
91101-2606
US

V. Phone/Fax

Practice location:
  • Phone: 626-683-6536
  • Fax:
Mailing address:
  • Phone: 626-683-6536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT3997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: