Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043774458 |
---|---|
Provider Name | Daisy Evelyn Flores |
First Address | Long Beach, CA 90810-1878 |
Second Address | Long Beach, CA 90810-1878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2019 |
Last Update Date | 30/01/2019 |