Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023278702 |
---|---|
Provider Name | Elia De La Riva |
First Address | Los Angeles, CA 90063-2020 |
Second Address | Los Angeles, CA 90057-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 16/06/2008 |