Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 34972 | CA |
NPI | 1003069360 |
---|---|
Provider Name | Elizabeth Shirley Cavazos |
First Address | Redlands, CA 92373-0722 |
Second Address | Redlands, CA 92373-4852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2008 |
Last Update Date | 30/10/2008 |