Provider Demographics
NPI:1629416912
Name:NYATHERA, RASHIDA
Entity Type:Individual
Prefix:
First Name:RASHIDA
Middle Name:
Last Name:NYATHERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 CORSON ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1555
Mailing Address - Country:US
Mailing Address - Phone:626-319-9304
Mailing Address - Fax:
Practice Address - Street 1:1518 W. GARVEY AVE. NORTH
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-962-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner