Provider Demographics
NPI:1104601715
Name:BRIONES, CLARISSA MAY (PT DPT)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:MAY
Last Name:BRIONES
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 ORANGE AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1494
Mailing Address - Country:US
Mailing Address - Phone:949-395-7957
Mailing Address - Fax:
Practice Address - Street 1:23100 EUCALYPTUS AVE STE C
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5439
Practice Address - Country:US
Practice Address - Phone:951-379-1500
Practice Address - Fax:951-379-1501
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist