Individual
MR. MARCOS ANTONIOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT ASSISTANT
Contact information
Practice address
330 N HAYWORTH AVE, LOS ANGELES, CA 90048-2702
(323) 852-9200
Mailing address
2537 PACIFIC COAST HWY STE D, TORRANCE, CA 90505-7063
(310) 977-4912
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT2215
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A2484669
STATE DRIVERS LICENSE
CA
Enumeration date
07/16/2019
Last updated
07/16/2019
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