Healthcare Provider Details

I. General information

NPI: 1548431364
Provider Name (Legal Business Name): JONATHAN ESGUERRA BUMANLAG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 WILSHIRE BLVD STE 314
LOS ANGELES CA
90010-2347
US

IV. Provider business mailing address

3540 WILSHIRE BLVD STE 314
LOS ANGELES CA
90010-2347
US

V. Phone/Fax

Practice location:
  • Phone: 213-389-1141
  • Fax: 213-389-1171
Mailing address:
  • Phone: 213-389-1141
  • Fax: 213-389-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028059
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: