Basic Information
| Provider Information | |||||||||
| NPI: | 1376671271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEDOLLA | ||||||||
| FirstName: | ESPERANZA | ||||||||
| MiddleName: | SAUCEDO | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 S DE LACEY AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263957100 | ||||||||
| FaxNumber: | 6263957270 | ||||||||
| Practice Location | |||||||||
| Address1: | 12510 VAN NUYS BLVD. | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188973346 | ||||||||
| FaxNumber: | 8188966213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.