Provider Demographics
NPI:1639416795
Name:CLARA, INGRID VEDILIA
Entity Type:Individual
Prefix:MISS
First Name:INGRID
Middle Name:VEDILIA
Last Name:CLARA
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 1:2500 E FOOTHILL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7112
Mailing Address - Country:US
Mailing Address - Phone:626-463-1021
Mailing Address - Fax:
Practice Address - Street 1:2500 E FOOTHILL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-7112
Practice Address - Country:US
Practice Address - Phone:626-463-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner