Healthcare Provider Details

I. General information

NPI: 1538100425
Provider Name (Legal Business Name): VLADISLAV BAKAL RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 W AVENUE J #E
LANCASTER CA
93534-3685
US

IV. Provider business mailing address

24 HAMMOND UNIT C
IRVINE CA
92618-1680
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-0884
  • Fax: 661-942-9714
Mailing address:
  • Phone: 949-770-6022
  • Fax: 949-770-7084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: