Provider Demographics
NPI:1396284964
Name:MARIANO, ALDWIN JOHN ESTROSA (PT)
Entity type:Individual
Prefix:MR
First Name:ALDWIN JOHN
Middle Name:ESTROSA
Last Name:MARIANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 CAMINITO NOVARA # 2
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-3140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8790 CUYAMACA ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4295
Practice Address - Country:US
Practice Address - Phone:619-596-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292845225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist