Provider Demographics
NPI:1508549650
Name:DOLZ, EPHRAIM (PTA)
Entity Type:Individual
Prefix:
First Name:EPHRAIM
Middle Name:
Last Name:DOLZ
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 1:23100 AVENUE SAN LUIS APT 177
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1021
Mailing Address - Country:US
Mailing Address - Phone:818-746-7238
Mailing Address - Fax:
Practice Address - Street 1:1464 MADERA RD STE I-1
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3077
Practice Address - Country:US
Practice Address - Phone:805-306-1622
Practice Address - Fax:805-306-1611
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52617225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant