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General NPI Number Information
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NPI Number | 1649796210
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Entity Type | Individual
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Provider Name | RAYMUND DIAZ PARPANA JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 215 N STATE COLLEGE BLVD
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City | ANAHEIM
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State | CA
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Zip | 92806-2913
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Country | US
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Telephone | 714-999-6596
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Fax |
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Provider Business Mailing Address
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Address Line | 20 LEGACY WAY
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-5566
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Country | US
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Telephone | 949-302-7808
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 48802
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License Number State | CA
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