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1972269975
CARISSA RAE VAN MIERLO
LAGUNA HILLS, CA
NPI
1972269975
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Former Name
CARISSA RAE TENNEY
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
Enumeration Date
2021-11-14
Last Update Date
2021-11-14
Business Address
CARISSA RAE VAN MIERLO
23961 CALLE DE LA MAGDALENA STE 119
LAGUNA HILLS, CA 92653-3616
Phone number: 949-837-5111
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Mailing Address
CARISSA RAE VAN MIERLO
2 DAYLILY
RANCHO SANTA MARGARITA, CA 92688-1442
Phone number: 949-290-1079
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