Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1427695774 |
---|---|
Provider Name | Ingrid Michelle Naveira |
First Address | Los Angeles, CA 90063-2839 |
Second Address | Los Angeles, CA 90063-2839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2019 |
Last Update Date | 27/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002571777 | IHSS (01) | CA |