Healthcare Provider Details

I. General information

NPI: 1316617764
Provider Name (Legal Business Name): WILLIAM BARCLAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W OLYMPIC BLVD STE 415
LOS ANGELES CA
90064-1536
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 415
LOS ANGELES CA
90064-1536
US

V. Phone/Fax

Practice location:
  • Phone: 424-225-1845
  • Fax: 310-933-4803
Mailing address:
  • Phone: 424-225-1845
  • Fax: 310-933-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number301037
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: