Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003363433 |
---|---|
Provider Name | Adriana Cornejo |
First Address | Los Angeles, CA 90041-1744 |
Second Address | Arcadia, CA 91006-2314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 26/05/2021 |