Provider Demographics
NPI:1548431364
Name:BUMANLAG, JONATHAN ESGUERRA (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ESGUERRA
Last Name:BUMANLAG
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 1:3540 WILSHIRE BLVD STE 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2347
Mailing Address - Country:US
Mailing Address - Phone:213-389-1141
Mailing Address - Fax:213-389-1171
Practice Address - Street 1:3540 WILSHIRE BLVD STE 314
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2347
Practice Address - Country:US
Practice Address - Phone:213-389-1141
Practice Address - Fax:213-389-1171
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028059225100000X
CA34855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028059OtherLICENSE