Healthcare Provider Details

I. General information

NPI: 1487347472
Provider Name (Legal Business Name): AVA LILIANA WOYNO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E GLENOAKS BLVD STE 230
GLENDALE CA
91207-2127
US

IV. Provider business mailing address

221 E GLENOAKS BLVD
GLENDALE CA
91207-2085
US

V. Phone/Fax

Practice location:
  • Phone: 763-516-4327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number489920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: