Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 34242 | CA |
N | 111NN1001X | Nutrition | 34242 | CA |
N | 111NP0017X | Pediatric Chiropractor | 34242 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | 34242 | CA |
NPI | 1952967812 |
---|---|
Provider Name | Dr. Martha Kebede Mekonen |
First Address | San Diego, CA 92108 |
Second Address | San Diego, CA 92108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2019 |
Last Update Date | 16/05/2019 |