Provider Demographics
NPI:1538543053
Name:EMPERATRIZ, VASTI (PTA)
Entity type:Individual
Prefix:
First Name:VASTI
Middle Name:
Last Name:EMPERATRIZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:VASTI
Other - Middle Name:
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 GOLDEN SHR
Mailing Address - Street 2:250
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4246
Mailing Address - Country:US
Mailing Address - Phone:866-414-0448
Mailing Address - Fax:800-985-5002
Practice Address - Street 1:330 GOLDEN SHR
Practice Address - Street 2:250
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4246
Practice Address - Country:US
Practice Address - Phone:866-414-0448
Practice Address - Fax:800-985-5002
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6553208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation