Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013565761 |
---|---|
Provider Name | Gabriela Anahi Leon |
First Address | Los Angeles, CA 90004-2306 |
Second Address | Los Angeles, CA 90015-3012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 08/11/2019 |