Healthcare Provider Details

I. General information

NPI: 1982140190
Provider Name (Legal Business Name): ILIA ARIETA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 OAK PARK BLVD
PLEASANT HILL CA
94523-4601
US

IV. Provider business mailing address

301 MORELLO AVE
MARTINEZ CA
94553-3525
US

V. Phone/Fax

Practice location:
  • Phone: 925-930-0545
  • Fax: 925-930-0717
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 8707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: