Provider Demographics
NPI:1881990059
Name:PABALAN, EDWIN SALURIO (PTA)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:SALURIO
Last Name:PABALAN
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 1:5 AMELIA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92656-6051
Mailing Address - Country:US
Mailing Address - Phone:949-584-2244
Mailing Address - Fax:877-864-4810
Practice Address - Street 1:5 AMELIA
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92656-6051
Practice Address - Country:US
Practice Address - Phone:949-584-2244
Practice Address - Fax:877-864-4810
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8992225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant