Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT29109 | CA |
NPI | 1124067392 |
---|---|
Provider Name | Cristina E. Bullard Cutone |
First Address | Dana Point, CA 92629-2561 |
Second Address | Santa Ana, CA 92701-4134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 08/07/2007 |