Healthcare Provider Details

I. General information

NPI: 1982360152
Provider Name (Legal Business Name): MICHAEL J OPARKA JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 WILSHIRE BLVD
SANTA MONICA CA
90401-1409
US

IV. Provider business mailing address

3723 PUEBLO AVE
LOS ANGELES CA
90032-1630
US

V. Phone/Fax

Practice location:
  • Phone: 310-656-8600
  • Fax:
Mailing address:
  • Phone: 757-641-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51186
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: