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General NPI Number Information
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NPI Number | 1720853856
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Entity Type | Individual
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Provider Name | ISAIAH PAGCALIWANGAN
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Gender | Male
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 6425 MILES AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4315
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Country | US
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Telephone | 213-589-5941
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 W HELLMAN AVE
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City | ALHAMBRA
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State | CA
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Zip | 91803-2556
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 52769
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License Number State | CA
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