Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 32884 | CA |
NPI | 1376697458 |
---|---|
Provider Name | Diana Cristina Molina |
First Address | Costa Mesa, CA 92627-0217 |
Second Address | Santa Ana, CA 92707-5302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32884 | P.T LICENSE NUMBER (01) | CA |