Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 40669 | CA |
NPI | 1043649387 |
---|---|
Provider Name | Cassandra Jaojoco |
First Address | Huntington Beach, CA 92648-1349 |
Second Address | Huntington Beach, CA 92648-1349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2013 |
Last Update Date | 07/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55-6539 | (02) | CA |