Basic Information
| Provider Information | |||||||||
| NPI: | 1487102737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUMONCEAUX | ||||||||
| FirstName: | ALAINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W MISSION BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917661799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096209700 | ||||||||
| FaxNumber: | 9096209800 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 E 4TH ST STE 140A | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148844736 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2016 | ||||||||
| LastUpdateDate: | 09/15/2016 | ||||||||
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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 | 225200000X | 11143 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 11143 | 01 | CA | PTA LICENSE | OTHER |