Provider Demographics
NPI:1538056346
Name:MAPUA, KATELYNE IZEL
Entity type:Individual
Prefix:
First Name:KATELYNE IZEL
Middle Name:
Last Name:MAPUA
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 1:18364 EVENING PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-0496
Mailing Address - Country:US
Mailing Address - Phone:714-251-1003
Mailing Address - Fax:
Practice Address - Street 1:237 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5923
Practice Address - Country:US
Practice Address - Phone:877-323-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY1744596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist