Provider Demographics
NPI:1447548433
Name:DE LARA, NINA ROSANA JOVES (DPT)
Entity type:Individual
Prefix:
First Name:NINA ROSANA
Middle Name:JOVES
Last Name:DE LARA
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 1:1409 OHARA CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7862
Mailing Address - Country:US
Mailing Address - Phone:619-267-4234
Mailing Address - Fax:
Practice Address - Street 1:321 E ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2667
Practice Address - Country:US
Practice Address - Phone:619-422-0404
Practice Address - Fax:619-422-4153
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist