Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 43106 | CA |
NPI | 1407463847 |
---|---|
Provider Name | Dr. Twyla Evano |
First Address | Azusa, CA 91702-6801 |
Second Address | Pomona, CA 91767-1933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2020 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43106 | PHYSICAL THERAPY BOARD OF CALIFORNIA (01) | CA |