Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003456443 |
---|---|
Provider Name | Jeanette Gavia |
First Address | Chatsworth, CA 91311-4903 |
Second Address | Chatsworth, CA 91311-4903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2020 |
Last Update Date | 14/01/2020 |