Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT28428 | CA |
NPI | 1003205675 |
---|---|
Provider Name | Anne Rojo |
First Address | Eastvale, CA 92880-0789 |
Second Address | Eastvale, CA 92880-0789 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 20/01/2015 |