Provider Demographics
NPI:1124691704
Name:COTANGCO, CHYNA FUSTER (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHYNA
Middle Name:FUSTER
Last Name:COTANGCO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 E IMPERIAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6735
Mailing Address - Country:US
Mailing Address - Phone:714-256-5074
Mailing Address - Fax:714-256-0770
Practice Address - Street 1:3300 IRVINE AVE STE 130
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3119
Practice Address - Country:US
Practice Address - Phone:949-271-0053
Practice Address - Fax:949-271-9453
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist