Provider Demographics
NPI:1891546776
Name:MOPERA, KIANA
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:
Last Name:MOPERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 BACCARAT CT
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-9244
Mailing Address - Country:US
Mailing Address - Phone:909-677-6972
Mailing Address - Fax:
Practice Address - Street 1:2258 BACCARAT CT
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-9244
Practice Address - Country:US
Practice Address - Phone:909-677-6972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist