Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT38421 | CA |
NPI | 1013279447 |
---|---|
Provider Name | Allison D Jurisch |
First Address | Fullerton, CA 92832-1310 |
Second Address | Fullerton, CA 92832-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 15/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT38421 | LICENSE (01) | CA |