Provider Demographics
NPI:1942585500
Name:CHUJO, LETICIA GUILLEN (PT)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:GUILLEN
Last Name:CHUJO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:A
Other - Last Name:GUILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5905 SEVERIN DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3806
Mailing Address - Country:US
Mailing Address - Phone:619-589-2606
Mailing Address - Fax:619-464-0900
Practice Address - Street 1:3452 E FOOTHILL BLVD STE 700
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3167
Practice Address - Country:US
Practice Address - Phone:866-554-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFP765ZMedicare PIN