Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 26215 | CA |
NPI | 1093091191 |
---|---|
Provider Name | Charlowe Mesina |
First Address | San Jose, CA 95153-0738 |
Second Address | San Jose, CA 95148-3527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2011 |
Last Update Date | 02/11/2011 |