Provider Demographics
NPI:1164051397
Name:FOGLIA, MARC-OLIVIER ROGER (PTA)
Entity Type:Individual
Prefix:MR
First Name:MARC-OLIVIER
Middle Name:ROGER
Last Name:FOGLIA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 JASMINE AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4914
Mailing Address - Country:US
Mailing Address - Phone:310-926-6798
Mailing Address - Fax:
Practice Address - Street 1:5401 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1006
Practice Address - Country:US
Practice Address - Phone:323-465-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA48690225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant