MEDICARE: RITCHIE VAL AGUILERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	35677	CA

General Provider Information

NPI Number	:	1003204306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITCHIE VAL AGUILERA

Provider Business Mailing Address
First Line	:	2040 FAIR PARK AVE
Second Line	:	APT 206
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1985
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 FAIR PARK AVE
Second Line	:	APT 206
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-1985
Country	:	US
Telephone Number	:	818-985-5990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	01/08/2015

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Directions to “ RITCHIE VAL AGUILERA ” Practice Location

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