Provider Demographics
NPI:1013239839
Name:CANSECO, MARICAR (PT)
Entity type:Individual
Prefix:MRS
First Name:MARICAR
Middle Name:
Last Name:CANSECO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 MACKENZIE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3533
Mailing Address - Country:US
Mailing Address - Phone:619-271-3932
Mailing Address - Fax:619-271-3932
Practice Address - Street 1:550 E 8TH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2354
Practice Address - Country:US
Practice Address - Phone:619-474-3294
Practice Address - Fax:619-474-9304
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist