Provider Demographics
NPI:1740494889
Name:ITO, BILL SURANARONK (ATC)
Entity type:Individual
Prefix:MR
First Name:BILL
Middle Name:SURANARONK
Last Name:ITO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 S ALDENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2909
Mailing Address - Country:US
Mailing Address - Phone:707-237-1303
Mailing Address - Fax:
Practice Address - Street 1:531 S ALDENVILLE AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2909
Practice Address - Country:US
Practice Address - Phone:707-237-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer