Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013448737 |
---|---|
Provider Name | Ana Belen Gomez |
First Address | View Park, CA 90008-5118 |
Second Address | View Park, CA 90008-5118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 23/03/2017 |