Provider Demographics
NPI:1992987564
Name:ADOREMOS, WILHELM BADIOLA (RPT)
Entity type:Individual
Prefix:MR
First Name:WILHELM
Middle Name:BADIOLA
Last Name:ADOREMOS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7727 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4524
Mailing Address - Country:US
Mailing Address - Phone:818-445-4780
Mailing Address - Fax:
Practice Address - Street 1:2010 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1008
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3507
Practice Address - Country:US
Practice Address - Phone:818-445-4780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27939Medicare PIN