Healthcare Provider Details

I. General information

NPI: 1104041144
Provider Name (Legal Business Name): P AND A HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14566 SEVENTH STREET
VICTORVILLE CA
92392
US

IV. Provider business mailing address

24 HAMMOND UNIT C
IRVINE CA
92618
US

V. Phone/Fax

Practice location:
  • Phone: 760-843-0895
  • Fax: 760-843-0894
Mailing address:
  • Phone: 949-770-6022
  • Fax: 949-770-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberW18200A
License Number StateCA

VIII. Authorized Official

Name: ALBERTO AVI MARCIANO
Title or Position: PRESIDENT
Credential:
Phone: 949-770-6022