Provider Demographics
NPI:1518428960
Name:LIONGSON, CHRISTIAN STEVENS MIRANDA (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN STEVENS
Middle Name:MIRANDA
Last Name:LIONGSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 N NORMANDIE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5155
Mailing Address - Country:US
Mailing Address - Phone:213-570-7333
Mailing Address - Fax:
Practice Address - Street 1:1900 S LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-1408
Practice Address - Country:US
Practice Address - Phone:323-933-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist