Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA9676 | CA |
NPI | 1013498476 |
---|---|
Provider Name | Jennifer Ramirez |
First Address | Watsonville, CA 95076-6640 |
Second Address | Watsonville, CA 95076-3745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |