Provider Demographics
NPI:1487858254
Name:SHTEREV, BOJIL PETROV (PTA)
Entity Type:Individual
Prefix:
First Name:BOJIL
Middle Name:PETROV
Last Name:SHTEREV
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 1:6100 EDINGER AVE APT 129
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3288
Mailing Address - Country:US
Mailing Address - Phone:714-377-5624
Mailing Address - Fax:
Practice Address - Street 1:6100 EDINGER AVE APT 129
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3288
Practice Address - Country:US
Practice Address - Phone:714-377-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6516225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant