MEDICARE: MR. VICTORIANO LOFRANCO MILLANES JR. 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
1	225200000X	Physical Therapy Assistant	8150	CA

General Provider Information

NPI Number	:	1659571131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICTORIANO LOFRANCO MILLANES JR. PTA

Provider Business Mailing Address
First Line	:	11429 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3143
Country	:	US
Telephone Number	:	818-766-9551
Fax Number	:	818-508-1838

Provider Business Practice Location Address
First Line	:	11429 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3143
Country	:	US
Telephone Number	:	818-766-9551
Fax Number	:	818-508-1838

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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