Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PG20767 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PG20767 | CA |
NPI | 1043238520 |
---|---|
Provider Name | Christopher N La Rosa |
First Address | La Jolla, CA 92037 |
Second Address | San Diego, CA 92121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 02/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT20767 | (02) | |
WPT207670 | PPIN (01) |