Provider Demographics
NPI:1336624667
Name:RONQUILLO, ELENA LIZA (DPT)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:LIZA
Last Name:RONQUILLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:ELENA
Other - Middle Name:LIZA
Other - Last Name:RONQUILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:265 N EL CIELO RD STE A-101
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6940
Mailing Address - Country:US
Mailing Address - Phone:760-320-8814
Mailing Address - Fax:760-969-7043
Practice Address - Street 1:265 N EL CIELO RD STE A-101
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6940
Practice Address - Country:US
Practice Address - Phone:760-320-8814
Practice Address - Fax:760-969-7043
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty