Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 35584 | CA |
NPI | 1043598568 |
---|---|
Provider Name | Dr. Rajiv Vijayakumar |
First Address | Culver City, CA 90230-4640 |
Second Address | Culver City, CA 90230-4640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 01/08/2011 |