=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902022031
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN JUNIO TENGAN I P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 11/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9353 IMPERIAL HWY PM&R DEPT., GARDEN BLDG. (3RD FLOOR)
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90242-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-657-4803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9353 IMPERIAL HWY PM&R DEPT., GARDEN BLDG. (3RD FLOOR)
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90242-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-657-4803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT20769
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------