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General NPI Number Information
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NPI Number | 1053321406
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Entity Type | Individual
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Provider Name | MARTHA CERDA R.P.T., PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 7212 ORANGETHORPE AVE SUITE # 3
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City | BUENA PARK
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State | CA
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Zip | 90621-3341
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Country | US
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Telephone | 714-562-0966
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Fax | 888-789-3197
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Provider Business Mailing Address
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Address Line | 446 CADBROOK DRIVE
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City | LA PUENTE
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State | CA
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Zip | 91744-3715
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Country | US
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Telephone | 626-330-1440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 18734
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 15320
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License Number State | CA
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