MEDICARE: JOVEL HERNANDEZ ANGELES PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT19943	CA

General Provider Information

NPI Number	:	1194997080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOVEL HERNANDEZ ANGELES PT

Provider Business Mailing Address
First Line	:	402 S PROSPECTORS RD
Second Line	:	SUITE E
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1618
Country	:	US
Telephone Number	:	909-860-5382
Fax Number	:	909-860-5384

Provider Business Practice Location Address
First Line	:	402 S PROSPECTORS RD
Second Line	:	SUITE E
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1618
Country	:	US
Telephone Number	:	909-860-5382
Fax Number	:	909-860-5384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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