=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275716649
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILOCORP HEALTH CARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2007
-----------------------------------------------------
Last Update Date | 12/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3020 WILSHIRE BLVD SUITE 160A
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-738-0045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15913 ENADIA WAY
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91406-4007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-785-9892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VICTOR SANTOS
-----------------------------------------------------
Credential | R.P.T
-----------------------------------------------------
Telephone | 818-785-9892
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT29853
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT19896
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------