Provider Demographics
NPI:1639567720
Name:LOGRONO, HYACINTH BANTILAN
Entity Type:Individual
Prefix:MRS
First Name:HYACINTH
Middle Name:BANTILAN
Last Name:LOGRONO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17305 JOSIE CIR
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6771
Mailing Address - Country:US
Mailing Address - Phone:562-704-0639
Mailing Address - Fax:
Practice Address - Street 1:17305 JOSIE CIR
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6771
Practice Address - Country:US
Practice Address - Phone:562-704-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist