Provider Demographics
NPI:1659493203
Name:GUILLINTA, ELIZA MARIE (RPT)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:MARIE
Last Name:GUILLINTA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27024 WOLF CREEK TRL UNIT 21
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-2664
Mailing Address - Country:US
Mailing Address - Phone:310-415-5212
Mailing Address - Fax:
Practice Address - Street 1:28880 LYONS AVE SUITE 100
Practice Address - Street 2:
Practice Address - City:NEW HALL
Practice Address - State:CA
Practice Address - Zip Code:91307-2005
Practice Address - Country:US
Practice Address - Phone:661-290-2884
Practice Address - Fax:818-346-5948
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27900OtherPHYSICAL THERAPIST