Individual
JACQUELYN M DYLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3301 S HOOVER AVE, LOS ANGELES, CA 90089-0001
(213) 740-0215
(213) 821-1499
Mailing address
1640 MARENGO ST, #102, LOS ANGELES, CA 90033-1036
(213) 821-2559
(213) 821-1499
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT19562
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT19562
LICENSE
CA
Enumeration date
03/19/2007
Last updated
07/08/2007
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