Healthcare Provider Details

I. General information

NPI: 1982155289
Provider Name (Legal Business Name): NERMAN PIMENTEL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/27/2023
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 VALLEY BLVD STE 109A
EL MONTE CA
91732-3161
US

IV. Provider business mailing address

8510 BALBOA BLVD STE 150
NORTHRIDGE CA
91325-3583
US

V. Phone/Fax

Practice location:
  • Phone: 626-575-7500
  • Fax: 626-575-1956
Mailing address:
  • Phone: 818-637-2000
  • Fax: 818-654-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT10385
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: