Basic Information
| Provider Information | |||||||||
| NPI: | 1588812432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARAFFA | ||||||||
| FirstName: | SHIANA | ||||||||
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| Credential: | L.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6126 GLEN ABBEY WAY | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923364545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093555987 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9864 BALDWIN PL | ||||||||
| Address2: | |||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917312202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264331311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 09/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT 34147 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.