Provider Demographics
NPI:1831722628
Name:SEVILLA, PATRICIA BANDERA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:BANDERA
Last Name:SEVILLA
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 1:13104 GLEN CT UNIT 13
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1124
Mailing Address - Country:US
Mailing Address - Phone:562-291-8714
Mailing Address - Fax:
Practice Address - Street 1:13104 GLEN CT UNIT 13
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1124
Practice Address - Country:US
Practice Address - Phone:562-291-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19223208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation