Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 33138 | CA |
NPI | 1003195520 |
---|---|
Provider Name | Jessica Dimaunahan Sison |
First Address | Torrance, CA 90503-7003 |
Second Address | Torrance, CA 90503-7003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 15/08/2011 |