Provider Demographics
NPI:1861448995
Name:BESINGA, MARI MAGNOLIA JASMIN (PT)
Entity Type:Individual
Prefix:MS
First Name:MARI
Middle Name:MAGNOLIA JASMIN
Last Name:BESINGA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14513 RIO BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4430
Mailing Address - Country:US
Mailing Address - Phone:562-881-4431
Mailing Address - Fax:
Practice Address - Street 1:14513 RIO BLANCO RD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4430
Practice Address - Country:US
Practice Address - Phone:562-881-4431
Practice Address - Fax:714-221-2255
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 29179OtherPT LICENSE