Healthcare Provider Details

I. General information

NPI: 1790068567
Provider Name (Legal Business Name): TRICIA FAELDAN SUAREZ P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRICIA GOLEZ FAELDAN

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9338 MILLIONAIRE LN
RIVERSIDE CA
92508-9360
US

IV. Provider business mailing address

9338 MILLIONAIRE LN
RIVERSIDE CA
92508-9360
US

V. Phone/Fax

Practice location:
  • Phone: 909-856-0296
  • Fax:
Mailing address:
  • Phone: 909-856-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 9516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: