Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT18779 | CA |
NPI | 1003117193 |
---|---|
Provider Name | Denise L. Haman |
First Address | Agoura Hills, CA 91301-2030 |
Second Address | Ventura, CA 93004-1832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2010 |
Last Update Date | 05/11/2010 |