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General NPI Number Information
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NPI Number | 1629144472
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Entity Type | Individual
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Provider Name | TOMISLAV ANDRO SIMUNOVIC R.P.T
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Gender | Male
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2140 W OLYMPIC BLVD S. 301
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City | LOS ANGELES
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State | CA
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Zip | 90006-2206
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Country | US
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Telephone | 213-383-0191
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Fax |
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Provider Business Mailing Address
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Address Line | 1341 BROOKDALE AVE
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City | LA HABRA
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State | CA
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Zip | 90631-3221
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Country | US
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Telephone | 562-818-2974
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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 | PT12688
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License Number State | CA
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