Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | CA | |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1164949640 |
---|---|
Provider Name | Jean Rose Pana |
First Address | South El Monte, CA 91733-3543 |
Second Address | South El Monte, CA 91733-3543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2017 |
Last Update Date | 12/06/2019 |