Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053902304 |
---|---|
Provider Name | Cristina Guadalupe Chan |
First Address | Los Angeles, CA 90041-1744 |
Second Address | Arcadia, CA 91006-2314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2021 |
Last Update Date | 29/01/2021 |