Provider Demographics
NPI:1407006265
Name:MARIANO, JANICE AGAYA
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:AGAYA
Last Name:MARIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5616 RIVER WAY APT N
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1752
Mailing Address - Country:US
Mailing Address - Phone:714-443-1260
Mailing Address - Fax:714-443-1260
Practice Address - Street 1:5616 RIVER WAY APT N
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1752
Practice Address - Country:US
Practice Address - Phone:714-443-1260
Practice Address - Fax:714-443-1260
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist