Provider Demographics
NPI:1003358060
Name:SEMILLA, CRISTINA (PTA)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:SEMILLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2715
Mailing Address - Country:US
Mailing Address - Phone:800-707-5768
Mailing Address - Fax:888-723-3351
Practice Address - Street 1:4021 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2715
Practice Address - Country:US
Practice Address - Phone:800-707-5768
Practice Address - Fax:888-723-3351
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8722225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPTA 8722OtherCA PTA LICENSE