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1184219891
KENNETH MARK NIEDO CRUZ
GLENDALE, CA
NPI
1184219891
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: CA 49797)
Enumeration Date
2021-03-04
Last Update Date
2021-03-04
Business Address
KENNETH MARK NIEDO CRUZ PTA
1000 N CENTRAL AVE STE 110
GLENDALE, CA 91202-3685
Phone number: 818-243-8422
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Mailing Address
KENNETH MARK NIEDO CRUZ PTA
808 E WINDSOR RD APT 9
GLENDALE, CA 91205-2441
Phone number: 323-384-8912
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