Provider Demographics
NPI:1588053763
Name:POBRE, BRICCIO PATROCINIO GARCIA II (RPT)
Entity type:Individual
Prefix:MR
First Name:BRICCIO PATROCINIO
Middle Name:GARCIA
Last Name:POBRE
Suffix:II
Gender:M
Credentials:RPT
Other - Prefix:MR
Other - First Name:BRICCIO
Other - Middle Name:GARCIA
Other - Last Name:POBRE
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:701 S ADAMS ST
Mailing Address - Street 2:APT A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5206
Mailing Address - Country:US
Mailing Address - Phone:818-641-7197
Mailing Address - Fax:
Practice Address - Street 1:701 S ADAMS ST
Practice Address - Street 2:APT A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5206
Practice Address - Country:US
Practice Address - Phone:818-641-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist