Provider Demographics
NPI:1306177597
Name:QUINDIPAN, MICHAEL HECTOR (MPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HECTOR
Last Name:QUINDIPAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 WAWONA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4710
Mailing Address - Country:US
Mailing Address - Phone:323-255-6746
Mailing Address - Fax:
Practice Address - Street 1:4110 WAWONA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4710
Practice Address - Country:US
Practice Address - Phone:323-255-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist