Basic Information
| Provider Information | |||||||||
| NPI: | 1174840953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRELIOFF | ||||||||
| FirstName: | MAC | ||||||||
| MiddleName: | BRIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25022 DOGWOOD CT | ||||||||
| Address2: | |||||||||
| City: | STEVENSON RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913812211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612546172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 S ARROYO PKWY | ||||||||
| Address2: | STE. 100 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264034888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2010 | ||||||||
| LastUpdateDate: | 05/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.