Provider Demographics
NPI:1982186029
Name:VILLARUZ, KRISTINA MARIE LORENZO (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTINA MARIE
Middle Name:LORENZO
Last Name:VILLARUZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17435 SARITA AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-3590
Mailing Address - Country:US
Mailing Address - Phone:661-993-0090
Mailing Address - Fax:
Practice Address - Street 1:2200 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-6507
Practice Address - Country:US
Practice Address - Phone:310-316-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49468225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant