Healthcare Provider Details

I. General information

NPI: 1679201370
Provider Name (Legal Business Name): LENA FLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 TOWN CENTER DR
RANCHO CUCAMONGA CA
91730-0360
US

IV. Provider business mailing address

16565 EL REVINO DR
FONTANA CA
92336-5841
US

V. Phone/Fax

Practice location:
  • Phone: 909-948-1124
  • Fax:
Mailing address:
  • Phone: 408-797-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: