Provider Demographics
NPI:1417251349
Name:IRINGAN, JOSELITO RIZALDO BABARAN (LPT)
Entity Type:Individual
Prefix:
First Name:JOSELITO RIZALDO
Middle Name:BABARAN
Last Name:IRINGAN
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9723 COLLIE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6223
Mailing Address - Country:US
Mailing Address - Phone:573-718-0014
Mailing Address - Fax:
Practice Address - Street 1:9723 COLLIE WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6223
Practice Address - Country:US
Practice Address - Phone:573-718-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37212225100000X
MO114450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist