Basic Information
| Provider Information | |||||||||
| NPI: | 1003212291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VENEGAS | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 N FAIR OAKS AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911033618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266961400 | ||||||||
| FaxNumber: | 6266961450 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 E HUNTINGTON DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910063776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266231122 | ||||||||
| FaxNumber: | 6266231130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2014 | ||||||||
| LastUpdateDate: | 11/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 39975 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.