Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | CT | |
Y | 225000000X | Orthotic Fitter | CFM01542 | CT |
NPI | 1568408524 |
---|---|
Provider Name | Christine I Dimaio |
First Address | Rohnert Park, CA 94928-1650 |
Second Address | Rohnert Park, CA 94928-1650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 05/05/2021 |