Healthcare Provider Details

I. General information

NPI: 1760902209
Provider Name (Legal Business Name): POUILLOUX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S BEVERLY DR STE 500
LOS ANGELES CA
90035-1183
US

IV. Provider business mailing address

1125 S BEVERLY DR STE 500
LOS ANGELES CA
90035-1183
US

V. Phone/Fax

Practice location:
  • Phone: 310-714-4459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PHILIPPE POUILLOUX
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 310-714-4459