Healthcare Provider Details

I. General information

NPI: 1346547478
Provider Name (Legal Business Name): JANI CRIS JUNIO ANGELES PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4844 MONUMENT ST
SIMI VALLEY CA
93063-0424
US

IV. Provider business mailing address

4844 MONUMENT ST
SIMI VALLEY CA
93063-0424
US

V. Phone/Fax

Practice location:
  • Phone: 805-813-1743
  • Fax: 805-577-1388
Mailing address:
  • Phone: 805-813-1743
  • Fax: 805-577-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 6854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: