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General NPI Number Information
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NPI Number | 1114320744
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Entity Type | Individual
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Provider Name | ANGELA MARIE GEREZ-MARTINEZ AYSON DPT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 972 MESA VIEW ST
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City | UPLAND
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State | CA
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Zip | 91784-8000
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Country | US
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Telephone | 909-973-3856
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Fax |
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Provider Business Mailing Address
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Address Line | 3908 10TH ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-3522
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Country | US
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Telephone | 951-274-7744
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Fax | 951-274-7754
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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 | 41356
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT41356
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License Number State | CA
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