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General NPI Number Information
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NPI Number | 1407104839
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Entity Type | Individual
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Provider Name | TODD ANTWANN MCGUIRE
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Gender | Male
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 6645 WOODMAN AVE APT # 106
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City | VAN NUYS
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State | CA
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Zip | 91401-1050
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Country | US
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Telephone | 910-476-2233
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 270920
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City | LAS VEGAS
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State | NV
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Zip | 89127-4920
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Country | US
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Telephone | 910-476-2233
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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