Individual
MR. DOMILOU BONG UNIDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1416 E WINDSOR RD, GLENDALE, CA 91205-2755
(818) 441-8343
Mailing address
1416 E WINDSOR RD, GLENDALE, CA 91205-2755
(818) 441-8343
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 8644
CA
Other
Enumeration date
05/19/2016
Last updated
05/19/2016
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