Provider Demographics
NPI:1922542273
Name:SEVILLA-PEREZ, YAZMAR (DPT)
Entity Type:Individual
Prefix:
First Name:YAZMAR
Middle Name:
Last Name:SEVILLA-PEREZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:6852 BROCKTON AVE.
Practice Address - Street 2:SUITE 212
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506
Practice Address - Country:US
Practice Address - Phone:951-534-0600
Practice Address - Fax:951-534-0605
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA229849Medicare PIN
CACA229847Medicare PIN
CACA229846Medicare PIN
CACA229848Medicare PIN
CACA229844Medicare PIN
CACA229845Medicare PIN