Provider Demographics
NPI:1194048512
Name:BAGGAO, RIA MELODY LARON (PTA)
Entity type:Individual
Prefix:
First Name:RIA MELODY
Middle Name:LARON
Last Name:BAGGAO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27001 AYAMONTE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3403
Mailing Address - Country:US
Mailing Address - Phone:949-702-3430
Mailing Address - Fax:
Practice Address - Street 1:27001 AYAMONTE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3403
Practice Address - Country:US
Practice Address - Phone:949-702-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9143225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant