Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053555623 |
---|---|
Provider Name | Edward Barnes |
First Address | Lawndale, CA 90260-2744 |
Second Address | Lawndale, CA 90260-2152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2009 |
Last Update Date | 28/04/2009 |