Provider Demographics
NPI:1699972430
Name:KNOWLES, TY ANGELO (DEPARTMENT ADMIN)
Entity type:Individual
Prefix:MR
First Name:TY
Middle Name:ANGELO
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:DEPARTMENT ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1526 N EDGEMONT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5260
Mailing Address - Country:US
Mailing Address - Phone:323-783-8552
Mailing Address - Fax:323-783-5509
Practice Address - Street 1:1526 N EDGEMONT ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5260
Practice Address - Country:US
Practice Address - Phone:323-783-8552
Practice Address - Fax:323-783-5509
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography