Provider Demographics
NPI:1629195573
Name:RADA, JAPHET A (PT)
Entity Type:Individual
Prefix:MR
First Name:JAPHET
Middle Name:A
Last Name:RADA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11062 BOREN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6516
Mailing Address - Country:US
Mailing Address - Phone:909-653-4456
Mailing Address - Fax:909-653-4456
Practice Address - Street 1:11062 BOREN AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-6516
Practice Address - Country:US
Practice Address - Phone:909-653-4456
Practice Address - Fax:909-653-4456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT281930Medicare UPIN