Healthcare Provider Details

I. General information

NPI: 1669831715
Provider Name (Legal Business Name): JOSEPH JULIAN ARZADON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 WILSHIRE BLVD
LOS ANGELES CA
90048-5201
US

IV. Provider business mailing address

6221 WILSHIRE BLVD STE 616
LOS ANGELES CA
90048-5215
US

V. Phone/Fax

Practice location:
  • Phone: 323-939-7050
  • Fax:
Mailing address:
  • Phone: 323-939-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number47895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: