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General NPI Number Information
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NPI Number | 1184717795
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Entity Type | Organization
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Legal Business Name | VICTORIA MANGUNSONG
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 11354 MOUNTAIN VIEW AVE SUITE C
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City | LOMA LINDA
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State | CA
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Zip | 92354-3855
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Country | US
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Telephone | 909-796-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 11354 MOUNTAIN VIEW AVE SUITE C
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City | LOMA LINDA
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State | CA
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Zip | 92354-3855
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Country | US
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Telephone | 909-796-9400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VICTORIA P MANGUNSONG
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Credential | MPT
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Telephone | 909-796-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT26565
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License Number State | CA
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