Provider Demographics
NPI:1548341258
Name:SUTJONGDRO, MARIA ELGA (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELGA
Last Name:SUTJONGDRO
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Gender:F
Credentials:PT
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Mailing Address - Street 1:3250 LOMITA BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5014
Mailing Address - Country:US
Mailing Address - Phone:310-539-8800
Mailing Address - Fax:310-698-5414
Practice Address - Street 1:824 E CARSON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2262
Practice Address - Country:US
Practice Address - Phone:310-539-8800
Practice Address - Fax:310-698-5414
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA21685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist