Basic Information
Provider Information
NPI: 1316569718
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEL CARMEN
FirstName: CHRISTINA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2737 E NORM PL
Address2:  
City: ANAHEIM
State: CA
PostalCode: 928065040
CountryCode: US
TelephoneNumber: 7143941887
FaxNumber:  
Practice Location
Address1: 1111 W 6TH ST STE 111
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900171823
CountryCode: US
TelephoneNumber: 2136074400
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/08/2020
LastUpdateDate: 05/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251P0200XPT298349CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics

No ID Information.


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