Provider Demographics
NPI:1740200237
Name:MASAYON, HIRAM OWEN BRIAN (PT)
Entity Type:Individual
Prefix:
First Name:HIRAM OWEN BRIAN
Middle Name:
Last Name:MASAYON
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 1:6108 HART AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1628
Mailing Address - Country:US
Mailing Address - Phone:626-524-7579
Mailing Address - Fax:
Practice Address - Street 1:1663 BEVERLY BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5710
Practice Address - Country:US
Practice Address - Phone:213-250-0078
Practice Address - Fax:213-250-5578
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT29929Medicare PIN