Healthcare Provider Details

I. General information

NPI: 1689365462
Provider Name (Legal Business Name): ASHLEY HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CENTURY PARK E
LOS ANGELES CA
90067-1907
US

IV. Provider business mailing address

2208 HILLDALE AVE
SIMI VALLEY CA
93063-2632
US

V. Phone/Fax

Practice location:
  • Phone: 424-522-7132
  • Fax:
Mailing address:
  • Phone: 805-428-0743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT304047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: