Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023574647 |
---|---|
Provider Name | Jacqueline Garcia-Leon |
First Address | Torrance, CA 90509-2004 |
Second Address | Monrovia, CA 91016-2901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2019 |
Last Update Date | 18/07/2019 |