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General NPI Number Information
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NPI Number | 1679864797
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Entity Type | Individual
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Provider Name | RUBY FAITH OVERTON PTA
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Gender | Female
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Dates
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Enumeration Date | 04/23/2011
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Last Update Date | 04/23/2011
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Provider Practice Location Address
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Address Line | 6250 EL CAMINO REAL
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City | CARLSBAD
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State | CA
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Zip | 92009-1603
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Country | US
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Telephone | 760-476-2900
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Fax | 760-940-4007
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Provider Business Mailing Address
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Address Line | 2360 PASEO DE LAURA UNIT 61
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City | OCEANSIDE
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State | CA
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Zip | 92056-3721
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Country | US
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Telephone | 714-916-8870
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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 | 5494
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License Number State | CA
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