Provider Demographics
NPI:1699403667
Name:YNECO, FRAYNE GABRIELL BORJA (PT, DPT)
Entity type:Individual
Prefix:
First Name:FRAYNE GABRIELL
Middle Name:BORJA
Last Name:YNECO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9951 MISSION HILLS ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-3169
Mailing Address - Country:US
Mailing Address - Phone:818-823-0440
Mailing Address - Fax:
Practice Address - Street 1:177 N REINO RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3710
Practice Address - Country:US
Practice Address - Phone:805-586-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X, 2251X0800X
CA3028582251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports