Healthcare Provider Details

I. General information

NPI: 1124975248
Provider Name (Legal Business Name): MATTHEW COSIO RAGUINDIN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 DOLORES ST
LOS ANGELES CA
90065
US

IV. Provider business mailing address

345 PIONEER DRIVE UNIT 104 WEST
GLENDALE CA
91203
US

V. Phone/Fax

Practice location:
  • Phone: 818-369-7620
  • Fax:
Mailing address:
  • Phone: 818-731-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: