Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003156944 |
---|---|
Provider Name | Amanda Gomez |
First Address | Pasadena, CA 91105-2711 |
Second Address | Pasadena, CA 91105-2711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2013 |
Last Update Date | 09/04/2014 |