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NPI Code Detail

MEDICARE: RONALD PILAR COSTALES JR. P.T.

MEDICARE: RONALD PILAR COSTALES JR. P.T.
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
1225100000XPhysical TherapistPT29975CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT29975OTHERCALICENSE

General Provider Information

NPI Number : 1134220700
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD PILAR COSTALES JR. P.T.
Provider Business Mailing Address
First Line : 2681 W OLYMPIC BLVD
Second Line : SUITE 2201
City : LOS ANGELES
State : CA
Zip : 90006-2810
Country : US
Telephone Number : 213-383-7030
Fax Number : 213-383-7031
Provider Business Practice Location Address
First Line : 2681 W OLYMPIC BLVD
Second Line : SUITE 2201
City : LOS ANGELES
State : CA
Zip : 90006-2810
Country : US
Telephone Number : 213-383-7030
Fax Number : 213-383-7031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 07/08/2007

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Directions to “ RONALD PILAR COSTALES JR. P.T.” Practice Location

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