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General NPI Number Information
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NPI Number | 1184167397
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Entity Type | Individual
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Provider Name | LIZA KUSTANTIN
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Gender | Female
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 1515 N ALEXANDRIA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-5203
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Country | US
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Telephone | 323-660-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 930 PALM AVE 402
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4066
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Country | US
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Telephone | 586-596-0452
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT16697
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201009655
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License Number State | MI
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