Provider Demographics
NPI:1265006191
Name:RENDON, ASHLEY (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RENDON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BRISTOL ST STE J104
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7918
Mailing Address - Country:US
Mailing Address - Phone:949-386-7500
Mailing Address - Fax:949-386-7511
Practice Address - Street 1:2900 BRISTOL ST STE J104
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7918
Practice Address - Country:US
Practice Address - Phone:949-386-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3001632251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300163OtherLICENSE NUMBER