Basic Information
| Provider Information | |||||||||
| NPI: | 1124500665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASCENCIO | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | VALENTINE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | RRT RCP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ASCENCIO | ||||||||
| OtherFirstName: | LUIS | ||||||||
| OtherMiddleName: | VALENTINE | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | JR. | ||||||||
| OtherCredential: | RRT-CPFT-RCP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | SOUTHERN CALIF. KAISER PERMANENTE HOSPITAL | ||||||||
| Address2: | 8110 WOODMAN AVE BUILDING 5 | ||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183752000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SOUTHERN CALIF. KAISER PERMANENTE HOSPITAL | ||||||||
| Address2: | 8110 WOODMAN AVE BUILDING 5 | ||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183752000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2018 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2278P1006X | 16049 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Pulmonary Function Technologist |
No ID Information.