Provider Demographics
NPI:1154859379
Name:PARISE, ANTHONY S
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:S
Last Name:PARISE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44095 SONESTA WAY
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-3838
Mailing Address - Country:US
Mailing Address - Phone:760-574-1658
Mailing Address - Fax:
Practice Address - Street 1:44095 SONESTA WAY
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3838
Practice Address - Country:US
Practice Address - Phone:760-574-1658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer