Healthcare Provider Details

I. General information

NPI: 1578700167
Provider Name (Legal Business Name): JOEVIL UNGAB PADAYHAG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 WELLAND AVE APT. 26-B
TEMPLE CITY CA
91780-2951
US

IV. Provider business mailing address

5610 WELLAND AVE APT. 26-B
TEMPLE CITY CA
91780-2951
US

V. Phone/Fax

Practice location:
  • Phone: 626-203-9573
  • Fax: 626-446-4634
Mailing address:
  • Phone: 626-203-9573
  • Fax: 626-446-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: