Provider Demographics
NPI:1518363068
Name:GULDSTRAND, ARIEL (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:GULDSTRAND
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661994
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-8794
Mailing Address - Country:US
Mailing Address - Phone:310-592-9166
Mailing Address - Fax:
Practice Address - Street 1:4233 S DECATUR ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-4309
Practice Address - Country:US
Practice Address - Phone:310-592-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT00013082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer