Provider Demographics
NPI:1568626570
Name:MIJARES, NOVIE TAMBONG (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:NOVIE
Middle Name:TAMBONG
Last Name:MIJARES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SANDPOINT DR
Mailing Address - Street 2:
Mailing Address - City:RODEO
Mailing Address - State:CA
Mailing Address - Zip Code:94572-1933
Mailing Address - Country:US
Mailing Address - Phone:510-374-9560
Mailing Address - Fax:
Practice Address - Street 1:1020 SANDPOINT DR
Practice Address - Street 2:
Practice Address - City:RODEO
Practice Address - State:CA
Practice Address - Zip Code:94572-1933
Practice Address - Country:US
Practice Address - Phone:510-374-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist