Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC27505 | CA |
NPI | 1134266653 |
---|---|
Provider Name | Dr. Monthiraporn Pananusorn |
First Address | La Crescenta, CA 91224-0941 |
Second Address | Monterey Park, CA 91754-4715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 16/09/2010 |