Healthcare Provider Details

I. General information

NPI: 1770949232
Provider Name (Legal Business Name): JEFFREY CIPRIANO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11018 BENJAMIN LN
GRANADA HILLS CA
91344-3780
US

IV. Provider business mailing address

11018 BENJAMIN LN
GRANADA HILLS CA
91344-3780
US

V. Phone/Fax

Practice location:
  • Phone: 818-550-0395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: