Provider Demographics
NPI:1346547478
Name:ANGELES, JANI CRIS JUNIO (PTA)
Entity Type:Individual
Prefix:MR
First Name:JANI CRIS
Middle Name:JUNIO
Last Name:ANGELES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4844 MONUMENT ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-0424
Mailing Address - Country:US
Mailing Address - Phone:805-813-1743
Mailing Address - Fax:805-577-1388
Practice Address - Street 1:4844 MONUMENT ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-0424
Practice Address - Country:US
Practice Address - Phone:805-813-1743
Practice Address - Fax:805-577-1388
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant