Provider Demographics
NPI:1760494843
Name:ABIERA, SALVADOR LOLARGA III (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:LOLARGA
Last Name:ABIERA
Suffix:III
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 BALD EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4573
Mailing Address - Country:US
Mailing Address - Phone:626-536-0126
Mailing Address - Fax:
Practice Address - Street 1:1850 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:909-258-2220
Practice Address - Fax:909-258-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT148282251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT148282OtherPHYSICAL THERAPY LICENSE
CAWPT14828AMedicare ID - Type UnspecifiedPHYSICAL THERAPIST