Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT298027 | CA |
NPI | 1043844921 |
---|---|
Provider Name | Dr. Christina Marie Iezza |
First Address | Glendale, CA 91201-1267 |
Second Address | Brea, CA 92821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2020 |
Last Update Date | 28/08/2020 |