Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA50554 | CA |
NPI | 1013532936 |
---|---|
Provider Name | Kenneth Garcia Salomon |
First Address | Loma Linda, CA 92354-4110 |
Second Address | Loma Linda, CA 92354-4110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2020 |
Last Update Date | 16/06/2020 |