Basic Information
| Provider Information | |||||||||
| NPI: | 1841842366 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIAMBAO | ||||||||
| FirstName: | RAELYNN MARIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | QUIAMBAO | ||||||||
| OtherFirstName: | RAELYNN | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12766 LA TORTOLA | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921293071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583866458 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9610 GRANITE RIDGE DR STE C | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585055400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2019 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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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 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.