Provider Demographics
NPI:1629344296
Name:CUEZON, KRISTINE DONNA MASALTA (DPT)
Entity Type:Individual
Prefix:MISS
First Name:KRISTINE DONNA
Middle Name:MASALTA
Last Name:CUEZON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 W MADISON CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4997
Mailing Address - Country:US
Mailing Address - Phone:949-954-2016
Mailing Address - Fax:
Practice Address - Street 1:2774 W MADISON CIR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4997
Practice Address - Country:US
Practice Address - Phone:949-954-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist