1134560386 NPI number — MR. PAUL LOGRONIO PENOLIAR OTR/L C/NDT

Table of content: MR. PAUL LOGRONIO PENOLIAR OTR/L C/NDT (NPI 1134560386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134560386 NPI number — MR. PAUL LOGRONIO PENOLIAR OTR/L C/NDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PENOLIAR
Provider First Name:
PAUL
Provider Middle Name:
LOGRONIO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L C/NDT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134560386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 N KENWOOD ST APT 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91206-3549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-472-9584
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 N KENWOOD ST APT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91206-3549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-472-9584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OT6994 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com