Provider Demographics
NPI:1861859621
Name:ADIUBA, VINA (PT)
Entity Type:Individual
Prefix:
First Name:VINA
Middle Name:
Last Name:ADIUBA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VINA ESPERANZA
Other - Middle Name:ORTALIZ
Other - Last Name:CLAVEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT TECH
Mailing Address - Street 1:3077 N SHELLY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-9145
Mailing Address - Country:US
Mailing Address - Phone:702-445-1674
Mailing Address - Fax:
Practice Address - Street 1:3077 N SHELLY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-9145
Practice Address - Country:US
Practice Address - Phone:702-445-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist