Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 41435 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | 41435 | CA |
NPI | 1093123424 |
---|---|
Provider Name | Dr. Jillian Stewart |
First Address | San Juan Capistrano, CA 92675-2401 |
Second Address | San Juan Capistrano, CA 92675-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2014 |
Last Update Date | 29/04/2020 |