Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 40132 | CA |
NPI | 1134553050 |
---|---|
Provider Name | Julia Fatov |
First Address | Sacramento, CA 95864-3853 |
Second Address | Sacramento, CA 95864-3853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2013 |
Last Update Date | 14/07/2017 |