Provider Demographics
NPI:1609102557
Name:MARTHA CERDA, INC.
Entity Type:Organization
Organization Name:MARTHA CERDA, INC.
Other - Org Name:THERAPYSCIENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CERDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, PA-C
Authorized Official - Phone:714-562-0966
Mailing Address - Street 1:7212 ORANGETHORPE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3341
Mailing Address - Country:US
Mailing Address - Phone:714-562-0966
Mailing Address - Fax:888-789-3197
Practice Address - Street 1:7212 ORANGETHORPE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3341
Practice Address - Country:US
Practice Address - Phone:714-562-0966
Practice Address - Fax:888-789-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT18734OtherPT LICENSE