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General NPI Number Information
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NPI Number | 1508251836
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Entity Type | Individual
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Provider Name | MARK DARNOLD CAGAMPANG MAYOL
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Gender | Male
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 63 S PARKWOOD AVE APT 4
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City | PASADENA
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State | CA
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Zip | 91107-3538
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Country | US
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Telephone | 626-298-0603
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Fax |
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Provider Business Mailing Address
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Address Line | 1724 E WOODBURY RD
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City | PASADENA
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State | CA
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Zip | 91104-1539
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Country | US
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Telephone | 626-298-0603
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 037670
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License Number State | NY
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