Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033723929 |
---|---|
Provider Name | Daisy Jae Tajalle |
First Address | Long Beach, CA 90810-1878 |
Second Address | Long Beach, CA 90810-1878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2020 |
Last Update Date | 14/01/2021 |