Provider Demographics
NPI:1477368132
Name:MIRAMONTEZ, VICTORIA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:MIRAMONTEZ
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 1:217 N CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-5371
Mailing Address - Country:US
Mailing Address - Phone:559-472-6885
Mailing Address - Fax:
Practice Address - Street 1:577 S PEACH AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3952
Practice Address - Country:US
Practice Address - Phone:559-251-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant