Provider Demographics
NPI:1760957740
Name:RECENTE, DANILO (PTA)
Entity Type:Individual
Prefix:
First Name:DANILO
Middle Name:
Last Name:RECENTE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 YORK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4165 YORK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4639
Practice Address - Country:US
Practice Address - Phone:213-446-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2020-02-19
Deactivation Date:2018-10-05
Deactivation Code:
Reactivation Date:2020-02-19
Provider Licenses
StateLicense IDTaxonomies
CA9868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant