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NPI Code Detail

MEDICARE: MR. ROGELIO BAMBALAN NANIONG JR.

MEDICARE: MR. ROGELIO BAMBALAN NANIONG JR.
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 Assistant9023CA

General Provider Information

NPI Number : 1912395740
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROGELIO BAMBALAN NANIONG JR.
Provider Business Mailing Address
First Line : 512 W IMPERIAL AVE APT 1
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-2102
Country : US
Telephone Number : 310-598-0174
Fax Number :
Provider Business Practice Location Address
First Line : 3533 MOTOR AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-4806
Country : US
Telephone Number : 310-836-8900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/01/2015
Last Update Date : 01/12/2015

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