Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 37628 | CA |
NPI | 1629587233 |
---|---|
Provider Name | Elyse Haruko Minamide |
First Address | Rancho Santa Margarita, CA 92688-2882 |
Second Address | Tustin, CA 92780-2925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 26/09/2017 |