Provider Demographics
NPI:1194202754
Name:MALABANAN, WERVONN ESTEBAN (PT)
Entity Type:Individual
Prefix:MR
First Name:WERVONN
Middle Name:ESTEBAN
Last Name:MALABANAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W CLARA ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-8427
Mailing Address - Country:US
Mailing Address - Phone:805-986-7740
Mailing Address - Fax:
Practice Address - Street 1:22029 SATICOY ST
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1133
Practice Address - Country:US
Practice Address - Phone:818-887-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty