Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023295227 |
---|---|
Provider Name | Blanca Brown |
First Address | Burbank, CA 91504-4203 |
Second Address | Burbank, CA 91504-3704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 21/08/2008 |