Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043554876 |
---|---|
Provider Name | Ericka Serrano |
First Address | Lynwood, CA 90262-2636 |
Second Address | Lynwood, CA 90262-2636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2012 |
Last Update Date | 16/11/2012 |