Individual
KENNETH GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
23888 MULHOLLAND DRIVE, MS # 270, WOODLAND HILLS, CA 91364
(818) 875-1050
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
(310) 301-8714
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 4143
CA
Other
Enumeration date
04/22/2014
Last updated
04/22/2014
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