Provider Demographics
NPI:1053321406
Name:CERDA, MARTHA (RPT, PA-C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:CERDA
Suffix:
Gender:F
Credentials:RPT, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 CADBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-3715
Mailing Address - Country:US
Mailing Address - Phone:626-330-1440
Mailing Address - Fax:
Practice Address - Street 1:7212 ORANGETHORPE AVE
Practice Address - Street 2:SUITE # 3
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3341
Practice Address - Country:US
Practice Address - Phone:714-562-0966
Practice Address - Fax:888-789-3197
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18734225100000X
CAPA 15320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant