Provider Demographics
NPI:1417553785
Name:JUREIDINI, KARLYLE PONCE (DPT)
Entity Type:Individual
Prefix:MR
First Name:KARLYLE
Middle Name:PONCE
Last Name:JUREIDINI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:KYLE
Other - Middle Name:PONCE
Other - Last Name:JUREIDINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:241 IMPERIAL HWY STE 330
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1056
Mailing Address - Country:US
Mailing Address - Phone:714-297-0712
Mailing Address - Fax:805-527-9135
Practice Address - Street 1:241 IMPERIAL HWY STE 330
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1056
Practice Address - Country:US
Practice Address - Phone:714-297-0712
Practice Address - Fax:657-217-2764
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2996392251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic