MEDICARE: JUSTIN CARRIDO DPT

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	2251X0800X	Orthopedic Physical Therapist	301621	CA

General Provider Information

NPI Number	:	1740936434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN CARRIDO DPT

Provider Business Mailing Address
First Line	:	15944 LOS SERRANOS COUNTRY CLUB DR STE 250
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3992
Country	:	US
Telephone Number	:	909-907-0805
Fax Number	:	909-907-0735

Provider Business Practice Location Address
First Line	:	15944 LOS SERRANOS COUNTRY CLUB DR STE 250
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3992
Country	:	US
Telephone Number	:	909-907-0805
Fax Number	:	909-907-0735

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

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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Directions to “ JUSTIN CARRIDO DPT” Practice Location

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