Provider Demographics
NPI:1710567904
Name:PINAGAYAO, MUAMAR (PT)
Entity type:Individual
Prefix:
First Name:MUAMAR
Middle Name:
Last Name:PINAGAYAO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69535 JARDIN CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1216
Mailing Address - Country:US
Mailing Address - Phone:760-408-7474
Mailing Address - Fax:866-225-9947
Practice Address - Street 1:69472 SERENITY RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7921
Practice Address - Country:US
Practice Address - Phone:760-409-6383
Practice Address - Fax:866-225-9947
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist