Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 8722 | CA |
NPI | 1003358060 |
---|---|
Provider Name | Cristina Semilla |
First Address | Cypress, CA 90630-2715 |
Second Address | Cypress, CA 90630-2715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2016 |
Last Update Date | 08/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PTA 8722 | CA PTA LICENSE (01) | CA |