Provider Demographics
NPI:1164904256
Name:PAREDES-KINDER, ROXANA EVANGELINA (PT)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:EVANGELINA
Last Name:PAREDES-KINDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 E CHAPMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4141
Mailing Address - Country:US
Mailing Address - Phone:213-380-0401
Mailing Address - Fax:
Practice Address - Street 1:1966 E CHAPMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4141
Practice Address - Country:US
Practice Address - Phone:714-519-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28091261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy