Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR007819 | GA |
NPI | 1003039611 |
---|---|
Provider Name | Dr. Mariela Betina Perosino |
First Address | Roswell, GA 30076-1769 |
Second Address | Roswell, GA 30076-1769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 19/08/2010 |