Provider Demographics
NPI:1780822023
Name:CANTIMBUHAN, ELEONOR NOVERO (PT)
Entity type:Individual
Prefix:
First Name:ELEONOR
Middle Name:NOVERO
Last Name:CANTIMBUHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13123 CAROLYN ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8603
Mailing Address - Country:US
Mailing Address - Phone:213-300-2796
Mailing Address - Fax:213-489-4005
Practice Address - Street 1:13123 CAROLYN ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8603
Practice Address - Country:US
Practice Address - Phone:213-300-2796
Practice Address - Fax:213-489-4005
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT17243OtherCALIFORNIA PHYSICAL THERAPY LICENSE