Provider Demographics
NPI:1649475500
Name:SIACUNCO, JOSEPHINE FLORES (PT)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:FLORES
Last Name:SIACUNCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JOSEFINA
Other - Middle Name:FLORES
Other - Last Name:SIACUNCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:13596 CRESCENT HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1435
Mailing Address - Country:US
Mailing Address - Phone:909-627-8900
Mailing Address - Fax:
Practice Address - Street 1:1011 BALDWIN PARK BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5806
Practice Address - Country:US
Practice Address - Phone:626-851-5574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist