Provider Demographics
NPI:1043346117
Name:MALILIM, PRINCESS ROMA RESPLANDOR
Entity Type:Individual
Prefix:
First Name:PRINCESS ROMA
Middle Name:RESPLANDOR
Last Name:MALILIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRINCESS ROMA
Other - Middle Name:PARTOZA
Other - Last Name:RESPLANDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2205 CAROB WAY
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8355
Mailing Address - Country:US
Mailing Address - Phone:714-224-8339
Mailing Address - Fax:
Practice Address - Street 1:2205 CAROB WAY
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-8355
Practice Address - Country:US
Practice Address - Phone:714-224-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist