Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | IMF 51072 | CA |
NPI | 1043351877 |
---|---|
Provider Name | Delmy Carolina Cisneros |
First Address | Los Angeles, CA 90043-4461 |
Second Address | Pasadena, CA 91107-3406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |