Provider Demographics
NPI:1174190300
Name:SAAVEDRA, MARIA LAURA JOY QUILAO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA LAURA JOY
Middle Name:QUILAO
Last Name:SAAVEDRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:SAAVEDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:15729 CLARETTA AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-6749
Mailing Address - Country:US
Mailing Address - Phone:562-274-5070
Mailing Address - Fax:
Practice Address - Street 1:15729 CLARETTA AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-6749
Practice Address - Country:US
Practice Address - Phone:562-274-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20810208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4105857OtherDRIVER'S LICENSE