Provider Demographics
NPI:1013117407
Name:SEVILLA, EMILY GUZMAN - DIAZ (PTA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GUZMAN - DIAZ
Last Name:SEVILLA
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 1:11815 FARNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1513
Mailing Address - Country:US
Mailing Address - Phone:909-628-5132
Mailing Address - Fax:
Practice Address - Street 1:1740 S SAN DIMAS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-5108
Practice Address - Country:US
Practice Address - Phone:909-394-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 1910225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant