Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 23658 | CA |
Y | 2251N0400X | Physical Therapist - Neurology | 23658 | CA |
NPI | 1114126091 |
---|---|
Provider Name | Jeanine Odette Yip |
First Address | Los Angeles, CA 90033 |
Second Address | Los Angeles, CA 90033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 12/07/2007 |