Healthcare Provider Details

I. General information

NPI: 1538056346
Provider Name (Legal Business Name): KATELYNE IZEL MAPUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N RIVERSIDE AVE
RIALTO CA
92376-5923
US

IV. Provider business mailing address

18364 EVENING PRIMROSE LN
SAN BERNARDINO CA
92407-0496
US

V. Phone/Fax

Practice location:
  • Phone: 877-323-4283
  • Fax:
Mailing address:
  • Phone: 714-251-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberY1744596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: