Healthcare Provider Details

I. General information

NPI: 1467591586
Provider Name (Legal Business Name): YOGI S MATHARU D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 MARENGO ST HRA-102
LOS ANGELES CA
90033-1036
US

IV. Provider business mailing address

1640 MARENGO ST HRA-102
LOS ANGELES CA
90033-1036
US

V. Phone/Fax

Practice location:
  • Phone: 323-224-7070
  • Fax: 323-224-5359
Mailing address:
  • Phone: 323-224-7070
  • Fax: 323-224-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT23615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: