Provider Demographics
NPI:1194350355
Name:LIRIO, JOLLY KIRSTEN TOJINO
Entity type:Individual
Prefix:
First Name:JOLLY KIRSTEN
Middle Name:TOJINO
Last Name:LIRIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3328
Mailing Address - Country:US
Mailing Address - Phone:818-247-4476
Mailing Address - Fax:
Practice Address - Street 1:330 MISSION RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3328
Practice Address - Country:US
Practice Address - Phone:818-247-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist