Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043742174 |
---|---|
Provider Name | Gena White |
First Address | Newhall, CA 91321-2511 |
Second Address | Newhall, CA 91321-2511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 29/03/2017 |