Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023438207 |
---|---|
Provider Name | Joel Gemino |
First Address | Long Beach, CA 90814-1001 |
Second Address | Long Beach, CA 90814-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2014 |
Last Update Date | 25/04/2014 |