Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 35096 | CA |
NPI | 1053634584 |
---|---|
Provider Name | Alicia Martinez |
First Address | El Cajon, CA 92019-1255 |
Second Address | San Diego, CA 92102-3713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2010 |
Last Update Date | 11/03/2010 |