Provider Demographics
NPI:1255119848
Name:VICTORIANO, JANN-ERIC (PT, DPT)
Entity type:Individual
Prefix:
First Name:JANN-ERIC
Middle Name:
Last Name:VICTORIANO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3409
Mailing Address - Country:US
Mailing Address - Phone:562-480-7991
Mailing Address - Fax:
Practice Address - Street 1:3518 ARBOR RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-3409
Practice Address - Country:US
Practice Address - Phone:562-480-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist