Provider Demographics
NPI:1104671155
Name:AGLUBA, CHRIS
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:AGLUBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20220 SORRENTO LN APT 303
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4474
Mailing Address - Country:US
Mailing Address - Phone:808-223-4910
Mailing Address - Fax:
Practice Address - Street 1:38600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4483
Practice Address - Country:US
Practice Address - Phone:808-223-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT305691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist