Individual
MARK TAVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
101 S 1ST ST STE 1800, BURBANK, CA 91502-1959
(818) 558-7252
(818) 558-7312
Mailing address
8510 BALBOA BLVD STE 150, NORTHRIDGE, CA 91325-5810
(818) 654-3400
(818) 654-3417
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA48496
CA
Other
Enumeration date
05/30/2018
Last updated
05/30/2018
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