Provider Demographics
NPI:1467166504
Name:JUWONO, MAURICE (PTA)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:JUWONO
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 1:25115 AVENUE STANFORD STE B135
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1290
Mailing Address - Country:US
Mailing Address - Phone:661-259-2621
Mailing Address - Fax:661-259-2651
Practice Address - Street 1:25830 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2004
Practice Address - Country:US
Practice Address - Phone:661-259-2621
Practice Address - Fax:661-259-2651
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52053225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant