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NPI Code Detail

MEDICARE: EDWARD JASTIA FERNANDEZ PTA

MEDICARE:   EDWARD JASTIA FERNANDEZ  PTA
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
1225200000XPhysical Therapy Assistant48715CA

General Provider Information

NPI Number : 1609391887
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD JASTIA FERNANDEZ PTA
Provider Business Mailing Address
First Line : 27125 SIERRA HWY STE 203
Second Line :
City : CANYON COUNTRY
State : CA
Zip : 91351-5429
Country : US
Telephone Number : 661-250-9940
Fax Number : 661-250-9959
Provider Business Practice Location Address
First Line : 3425 W VICTORY BLVD
Second Line :
City : BURBANK
State : CA
Zip : 91505-1545
Country : US
Telephone Number : 818-955-8855
Fax Number : 818-955-8833
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 08/08/2017

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Directions to “ EDWARD JASTIA FERNANDEZ PTA” Practice Location

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