Basic Information
| Provider Information | |||||||||
| NPI: | 1184200263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARIOS | ||||||||
| FirstName: | OBDULIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1920 PEYTON AVE APT 215 | ||||||||
| Address2: | |||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915043576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129832049 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6400 LAUREL CANYON BLVD STE 500 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916061562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189016376 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2021 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.