Provider Demographics
NPI:1396225322
Name:WADDELL, JUSTINN FRANK (RCP, RRT)
Entity Type:Individual
Prefix:MR
First Name:JUSTINN
Middle Name:FRANK
Last Name:WADDELL
Suffix:
Gender:M
Credentials:RCP, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10844 OXNARD ST APT 17
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-5043
Mailing Address - Country:US
Mailing Address - Phone:818-605-9078
Mailing Address - Fax:
Practice Address - Street 1:13651 WILLARD ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-815-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33912227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered