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General NPI Number Information
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NPI Number | 1295628352
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Entity Type | Individual
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Provider Name | ROGER IRA LOYOLA III
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Gender | Male
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 289 W HUNTINGTON DR
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City | ARCADIA
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State | CA
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Zip | 91007-3495
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Country | US
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Telephone | 626-396-8150
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Fax |
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Provider Business Mailing Address
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Address Line | 64 N OAK AVE UNIT 9
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City | PASADENA
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State | CA
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Zip | 91107-5817
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Country | US
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Telephone | 818-388-9840
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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 | 51257
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License Number State | CA
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