Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 42025 | CA |
NPI | 1073901955 |
---|---|
Provider Name | Dr. Roy-Carlo Maclang |
First Address | Glendale, CA 91206-1602 |
Second Address | Glendale, CA 91206-1602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2014 |
Last Update Date | 01/10/2015 |