Provider Demographics
NPI:1699010777
Name:DE DIOS, KINDRA NICOLE BERUMEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KINDRA NICOLE
Middle Name:BERUMEN
Last Name:DE DIOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N PLACENTIA AVE
Mailing Address - Street 2:#16
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2530
Mailing Address - Country:US
Mailing Address - Phone:661-992-8012
Mailing Address - Fax:
Practice Address - Street 1:12411 SLAUSON AVE
Practice Address - Street 2:UNIT H
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2835
Practice Address - Country:US
Practice Address - Phone:562-693-5449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist