Provider Demographics
NPI:1578998761
Name:GARDE, MARIA RITA CHONA (PTA)
Entity Type:Individual
Prefix:
First Name:MARIA RITA CHONA
Middle Name:
Last Name:GARDE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 E MAPLE ST
Mailing Address - Street 2:APT 204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2589
Mailing Address - Country:US
Mailing Address - Phone:323-482-9915
Mailing Address - Fax:
Practice Address - Street 1:1116 E MAPLE ST
Practice Address - Street 2:APT 204
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2589
Practice Address - Country:US
Practice Address - Phone:323-482-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8953225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant