MEDICARE: MISS CHRISTINE ANNE MALLEN SAMONTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	10611	CA

General Provider Information

NPI Number	:	1659996205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHRISTINE ANNE MALLEN SAMONTE

Provider Business Mailing Address
First Line	:	2522 DEERFORD ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-3356
Country	:	US
Telephone Number	:	562-968-9064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2522 DEERFORD ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-3356
Country	:	US
Telephone Number	:	562-968-9064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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