Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT29878 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT29878 | CA |
NPI | 1285915280 |
---|---|
Provider Name | Aimee Miltenberger Diaz |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90089-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2011 |
Last Update Date | 17/09/2020 |