Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053660480 |
---|---|
Provider Name | Karen Guillory |
First Address | Commerce, CA 90040-2449 |
Second Address | Commerce, CA 90040-2449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2012 |
Last Update Date | 30/08/2012 |