Healthcare Provider Details

I. General information

NPI: 1972300549
Provider Name (Legal Business Name): CHRIS TIYAVARABOON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 MEDICAL CENTER DR STE 206
WEST HILLS CA
91307-4122
US

IV. Provider business mailing address

7325 MEDICAL CENTER DR STE 206
WEST HILLS CA
91307-4122
US

V. Phone/Fax

Practice location:
  • Phone: 818-340-8320
  • Fax:
Mailing address:
  • Phone: 818-340-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA50544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: