Provider Demographics
NPI:1821659137
Name:CARRIEDO-JAIME, NATASHA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:CARRIEDO-JAIME
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 1:30 N MADISON AVE UNIT 421
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4541
Mailing Address - Country:US
Mailing Address - Phone:951-529-5944
Mailing Address - Fax:
Practice Address - Street 1:30 N MADISON AVE UNIT 421
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4541
Practice Address - Country:US
Practice Address - Phone:951-529-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist