Provider Demographics
NPI:1366614463
Name:AMANTE, MARLAND FAITH MARIANO (PT)
Entity type:Individual
Prefix:
First Name:MARLAND FAITH
Middle Name:MARIANO
Last Name:AMANTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARLAND FAITH
Other - Middle Name:KAGUING
Other - Last Name:MARIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,
Mailing Address - Street 1:6510 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-0101
Mailing Address - Country:US
Mailing Address - Phone:949-375-8888
Mailing Address - Fax:
Practice Address - Street 1:12421 CENTRAL AVE
Practice Address - Street 2:SUITES A & B
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2664
Practice Address - Country:US
Practice Address - Phone:949-375-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015143171W00000X
CA36343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor