Provider Demographics
NPI:1952869430
Name:DELMO, LOURDES PRIMNE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:PRIMNE
Last Name:DELMO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 VICTORY BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1710
Mailing Address - Country:US
Mailing Address - Phone:562-833-8025
Mailing Address - Fax:
Practice Address - Street 1:15215 VICTORY BLVD APT 203
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1710
Practice Address - Country:US
Practice Address - Phone:562-833-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9556225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist