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General NPI Number Information
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NPI Number | 1497965867
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Entity Type | Individual
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Provider Name | JAY LOMIBAO PADILLO PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 01/24/2011
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Provider Practice Location Address
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Address Line | 409 S LA BREA AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-2321
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Country | US
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Telephone | 818-245-0210
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Fax | 818-827-3350
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Provider Business Mailing Address
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Address Line | 1254 N EVERETT ST
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City | GLENDALE
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State | CA
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Zip | 91207-1429
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Country | US
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Telephone | 818-245-0210
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Fax | 818-827-3350
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 28175
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License Number State | CA
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