Healthcare Provider Details

I. General information

NPI: 1083247324
Provider Name (Legal Business Name): JOHN DAVID MCDONALD II DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 S SEPULVEDA BLVD
LOS ANGELES CA
90045-2940
US

IV. Provider business mailing address

9714 REGENT ST APT 1
LOS ANGELES CA
90034-5122
US

V. Phone/Fax

Practice location:
  • Phone: 310-991-7751
  • Fax:
Mailing address:
  • Phone: 340-998-2996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: