Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043673874 |
---|---|
Provider Name | Alexxis Viridianna Acosta |
First Address | Riverside, CA 92506-4290 |
Second Address | Riverside, CA 92506-4290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 14/04/2021 |