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General NPI Number Information
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NPI Number | 1518428960
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Entity Type | Individual
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Provider Name | CHRISTIAN STEVENS MIRANDA LIONGSON PT
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Gender | Male
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 1900 S LONGWOOD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90016-1408
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Country | US
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Telephone | 323-933-1560
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Fax |
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Provider Business Mailing Address
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Address Line | 1627 N NORMANDIE AVE APT 2
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City | LOS ANGELES
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State | CA
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Zip | 90027-5155
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Country | US
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Telephone | 213-570-7333
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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 | 295604
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License Number State | CA
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