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General NPI Number Information
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NPI Number | 1861908451
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Entity Type | Individual
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Provider Name | TEO TODD LIZAN FLORES
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Gender | Male
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 1225 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90017-1901
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Country | US
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Telephone | 213-977-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 343 N VENDOME ST
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City | LOS ANGELES
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State | CA
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Zip | 90026-4525
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Country | US
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Telephone | 213-925-3600
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40511
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License Number State | CA
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