Basic Information
| Provider Information | |||||||||
| NPI: | 1144340985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRONENWETH | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WHALEY | ||||||||
| OtherFirstName: | REGINA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6521 YARMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913356217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184625077 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14640 VICTORY BLVD | ||||||||
| Address2: | #100 | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914111623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183746901 | ||||||||
| FaxNumber: | 8183746908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.