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General NPI Number Information
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NPI Number | 1740629302
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Entity Type | Individual
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Provider Name | JEFFREY ALLEN HOSTAK P.T.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 2208 W 7TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-4002
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Country | US
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Telephone | 213-637-2530
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Fax | 213-384-3373
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Provider Business Mailing Address
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Address Line | PO BOX 10432
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City | BEVERLY HILLS
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State | CA
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Zip | 90213-3432
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Country | US
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Telephone | 213-637-2530
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Fax | 213-384-3373
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 40177
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License Number State | CA
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