MEDICARE: CHRISTIAN STEVENS MIRANDA LIONGSON PT

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	295604	CA

General Provider Information

NPI Number	:	1518428960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN STEVENS MIRANDA LIONGSON PT

Provider Business Mailing Address
First Line	:	1627 N NORMANDIE AVE APT 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5155
Country	:	US
Telephone Number	:	213-570-7333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 S LONGWOOD AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-1408
Country	:	US
Telephone Number	:	323-933-1560
Fax Number	:

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

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	03/28/2019

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