Individual
IAN CESAR JR LUARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4922 LASALLE RD, HYATTSVILLE, MD 20782-3302
(301) 864-2333
(877) 828-2060
Mailing address
4922 LASALLE RD, HYATTSVILLE, MD 20782-3302
(240) 520-3345
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
26387
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447657507
NPI
MD
05
—
4374045-00
—
MD
Enumeration date
03/06/2017
Last updated
06/16/2017
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