Provider Demographics
NPI:1336864925
Name:LABAY, SOCORRO RIZALINA MARTINEZ
Entity Type:Individual
Prefix:
First Name:SOCORRO RIZALINA
Middle Name:MARTINEZ
Last Name:LABAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22681 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3221
Mailing Address - Country:US
Mailing Address - Phone:510-709-7864
Mailing Address - Fax:
Practice Address - Street 1:718 BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3698
Practice Address - Country:US
Practice Address - Phone:510-785-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50653225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant