Provider Demographics
NPI:1194109348
Name:PABIN, DESIREE N (DPT)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:N
Last Name:PABIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:30141 ANTELOPE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7001
Practice Address - Country:US
Practice Address - Phone:951-723-1866
Practice Address - Fax:951-973-7216
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA169894Medicare PIN
CACA169895Medicare PIN
CACA169899Medicare PIN
CACA169893Medicare PIN
CACA169900Medicare PIN
CACA169898Medicare PIN
CACA169897Medicare PIN
CACA169896Medicare PIN