Healthcare Provider Details

I. General information

NPI: 1205168713
Provider Name (Legal Business Name): THABET YOSRY KEROLS PSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 W 8TH ST STE 100
LOS ANGELES CA
90017-4422
US

IV. Provider business mailing address

518 E LEXINGTON DR APT 4
GLENDALE CA
91206-3642
US

V. Phone/Fax

Practice location:
  • Phone: 213-401-1970
  • Fax:
Mailing address:
  • Phone: 818-913-1583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: