Provider Demographics
NPI:1467591586
Name:MATHARU, YOGI S (DPT)
Entity Type:Individual
Prefix:
First Name:YOGI
Middle Name:S
Last Name:MATHARU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 MARENGO ST
Mailing Address - Street 2:HRA-102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1036
Mailing Address - Country:US
Mailing Address - Phone:323-224-7070
Mailing Address - Fax:323-224-5359
Practice Address - Street 1:1640 MARENGO ST
Practice Address - Street 2:HRA-102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1036
Practice Address - Country:US
Practice Address - Phone:323-224-7070
Practice Address - Fax:323-224-5359
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT236152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT23615OtherBLUE SHIELD
CAWPT23615AMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID#