Healthcare Provider Details

I. General information

NPI: 1144733023
Provider Name (Legal Business Name): ANGELA CUENTO MARIAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 ANDRIEUX ST
SONOMA CA
95476-6811
US

IV. Provider business mailing address

PO BOX 2946
SANTA ROSA CA
95405-0946
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-5000
  • Fax:
Mailing address:
  • Phone: 619-813-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number37568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: