Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 8639 | CA |
NPI | 1285843532 |
---|---|
Provider Name | Joanna Madrid |
First Address | Redondo Beach, CA 90278-5420 |
Second Address | Los Angeles, CA 90033-1029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |