Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023573110 |
---|---|
Provider Name | Dominic Bertrand Ceroni |
First Address | Chatsworth, CA 91311-4903 |
Second Address | Chatsworth, CA 91311-4903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2019 |
Last Update Date | 04/02/2019 |