Provider Demographics
NPI:1760506729
Name:TESTA, CARINA ESCUDERO (DPT)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:ESCUDERO
Last Name:TESTA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARINA
Other - Middle Name:MICHELE
Other - Last Name:ESCUDERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1035 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4023
Mailing Address - Country:US
Mailing Address - Phone:310-937-2323
Mailing Address - Fax:310-937-3399
Practice Address - Street 1:1035 AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-4023
Practice Address - Country:US
Practice Address - Phone:310-937-2323
Practice Address - Fax:310-937-3399
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT212852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT21285OtherPT LICENSE