Provider Demographics
NPI:1750419131
Name:NOGRA, MARIA ERNA (PHYSICAL THERAPY)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ERNA
Last Name:NOGRA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 W OLIVE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2459
Mailing Address - Country:US
Mailing Address - Phone:818-846-1441
Mailing Address - Fax:818-846-1419
Practice Address - Street 1:1624 W OLIVE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2459
Practice Address - Country:US
Practice Address - Phone:818-846-1441
Practice Address - Fax:818-846-1419
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28080174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 28080Medicare UPIN