Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1760677926 |
---|---|
Provider Name | Debra Alejo |
First Address | San Jose, CA 95124-4008 |
Second Address | San Jose, CA 95124-4008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 11/09/2007 |