Healthcare Provider Details

I. General information

NPI: 1295511426
Provider Name (Legal Business Name): ADILI RIKONDJA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W OLYMPIC BLVD STE 640
LOS ANGELES CA
90064-1525
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 640
LOS ANGELES CA
90064-1525
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number304772
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: