Provider Demographics
NPI:1679201370
Name:FLAIR, LENA
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:FLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16565 EL REVINO DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5841
Mailing Address - Country:US
Mailing Address - Phone:408-797-4724
Mailing Address - Fax:
Practice Address - Street 1:10590 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0360
Practice Address - Country:US
Practice Address - Phone:909-948-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist