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General NPI Number Information
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NPI Number | 1326216383
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Entity Type | Individual
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Provider Name | MARYVEE ASINO TAN PT
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Gender | Female
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 1041 HARBOR HEIGHTS DR UNIT I
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City | HARBOR CITY
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State | CA
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Zip | 90710-3086
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Country | US
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Telephone | 310-326-5093
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 HARBOR HEIGHTS DR UNIT I
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City | HARBOR CITY
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State | CA
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Zip | 90710-3086
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Country | US
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Telephone | 310-326-5093
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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 20930
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License Number State | CA
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