Healthcare Provider Details

I. General information

NPI: 1639312341
Provider Name (Legal Business Name): CALVIN BAGUIO TOLING PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W OLYMPIC BLVD 302
LOS ANGELES CA
90006-2207
US

IV. Provider business mailing address

2140 W OLYMPIC BLVD 302
LOS ANGELES CA
90006-2207
US

V. Phone/Fax

Practice location:
  • Phone: 213-487-7792
  • Fax:
Mailing address:
  • Phone: 213-487-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number21993-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number18444
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT - 37846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: