Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology |
NPI | 1558824367 |
---|---|
Provider Name | Dr. George Kopiloff II |
First Address | Rancho Cucamonga, CA 91701-3414 |
Second Address | Pomona, CA 91767-1923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2019 |
Last Update Date | 09/04/2019 |