Provider Demographics
NPI:1134560386
Name:PENOLIAR, PAUL LOGRONIO (OTR/L C/NDT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:LOGRONIO
Last Name:PENOLIAR
Suffix:
Gender:M
Credentials:OTR/L C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 N KENWOOD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3549
Mailing Address - Country:US
Mailing Address - Phone:818-472-9584
Mailing Address - Fax:
Practice Address - Street 1:332 N KENWOOD ST APT 4
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3549
Practice Address - Country:US
Practice Address - Phone:818-472-9584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT6994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist