Provider Demographics
NPI:1942414834
Name:IMATONG, CHARITO NACITO (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:MS
First Name:CHARITO
Middle Name:NACITO
Last Name:IMATONG
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8831 1/2 RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6334
Mailing Address - Country:US
Mailing Address - Phone:562-408-1877
Mailing Address - Fax:
Practice Address - Street 1:1955 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1807
Practice Address - Country:US
Practice Address - Phone:310-325-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist