Basic Information
| Provider Information | |||||||||
| NPI: | 1407345556 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DE LUNA | ||||||||
| FirstName: | NOLAN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1453 BLACKSTOCK AVE | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930653907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052316708 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7120 CORBIN AVE | ||||||||
| Address2: | |||||||||
| City: | RESEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913353618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188814540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2018 | ||||||||
| LastUpdateDate: | 05/04/2018 | ||||||||
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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 | 49291 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.