Provider Demographics
NPI:1659760163
Name:TAMONAN, GELLA ROSE TRINO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:GELLA ROSE
Middle Name:TRINO
Last Name:TAMONAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W WILSON AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2544
Mailing Address - Country:US
Mailing Address - Phone:818-653-7734
Mailing Address - Fax:
Practice Address - Street 1:331 W WILSON AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2544
Practice Address - Country:US
Practice Address - Phone:818-653-7734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist