Provider Demographics
NPI:1235524943
Name:VELANDRES, CLARISSA VILLAR (RPT)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:VILLAR
Last Name:VELANDRES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15853 E ROYAL ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-2200
Mailing Address - Country:US
Mailing Address - Phone:626-373-5858
Mailing Address - Fax:
Practice Address - Street 1:950 S FLOWER ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4186
Practice Address - Country:US
Practice Address - Phone:310-674-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist