Healthcare Provider Details

I. General information

NPI: 1073140364
Provider Name (Legal Business Name): MONA JENNIFER ESLAMIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 TORRANCE BLVD STE 100
TORRANCE CA
90503-5812
US

IV. Provider business mailing address

6632 EL RODEO RD
RANCHO PALOS VERDES CA
90275-4602
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-8555
  • Fax:
Mailing address:
  • Phone: 310-900-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: