Provider Demographics
NPI:1194330316
Name:CIPOLLA, ILARIA (LMT)
Entity type:Individual
Prefix:
First Name:ILARIA
Middle Name:
Last Name:CIPOLLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 W FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3400
Mailing Address - Country:US
Mailing Address - Phone:909-670-9951
Mailing Address - Fax:
Practice Address - Street 1:689 W FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3400
Practice Address - Country:US
Practice Address - Phone:909-670-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73790225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist