Healthcare Provider Details

I. General information

NPI: 1952478240
Provider Name (Legal Business Name): JOSE RAUL LONA D.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J RAUL LONA D.P.T

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 SANTA MONICA BLVD SUITE 435
LOS ANGELES CA
90025-6929
US

IV. Provider business mailing address

10474 SANTA MONICA BLVD SUITE 435
LOS ANGELES CA
90025-6929
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-4137
  • Fax: 310-274-1815
Mailing address:
  • Phone: 310-275-4137
  • Fax: 310-274-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number26406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: