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General NPI Number Information
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NPI Number | 1003616343
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Entity Type | Individual
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Provider Name | WILMER ENCELA EMBUSCADO JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 3392 MOTOR AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-3712
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Country | US
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Telephone | 310-742-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 7120 LA TIJERA BLVD APT D102
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City | LOS ANGELES
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State | CA
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Zip | 90045-2165
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Country | US
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Telephone | 310-866-1506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 53952
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License Number State | CA
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