Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 295825 | CA |
NPI | 1063041002 |
---|---|
Provider Name | Erica Nicole Brown |
First Address | La Verne, CA 91750-5202 |
Second Address | Pomona, CA 91767-2918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2020 |
Last Update Date | 02/04/2020 |