Provider Demographics
NPI:1861239089
Name:PAYAN, ERNEST MICHAEL III (DPT)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:MICHAEL
Last Name:PAYAN
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:ERNEST
Other - Middle Name:MICHAEL
Other - Last Name:PAYAN
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:ERN PAYAN
Mailing Address - Street 1:4302 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8430
Mailing Address - Country:US
Mailing Address - Phone:559-679-7358
Mailing Address - Fax:
Practice Address - Street 1:719 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2601
Practice Address - Country:US
Practice Address - Phone:310-260-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist