Provider Demographics
NPI:1316310048
Name:MORAN, MARIA ANNA RIZZA ROXAS
Entity type:Individual
Prefix:
First Name:MARIA ANNA RIZZA
Middle Name:ROXAS
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5211
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94524-0211
Mailing Address - Country:US
Mailing Address - Phone:925-324-2985
Mailing Address - Fax:
Practice Address - Street 1:111 CLEAVELAND RD APT 82
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3851
Practice Address - Country:US
Practice Address - Phone:925-324-2985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9895225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant