Basic Information
| Provider Information | |||||||||
| NPI: | 1053975417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLOIRENDO | ||||||||
| FirstName: | WILLAND PATRICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14050 MAGNOLIA BLVD APT 103 | ||||||||
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| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914231253 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5650 RESEDA BLVD | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913562230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188814261 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2019 | ||||||||
| LastUpdateDate: | 04/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 9404 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.