Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043813421 |
---|---|
Provider Name | Kiara Sybeth Carrasquillo Sanchez |
First Address | San Leandro, CA 94578-1132 |
Second Address | San Leandro, CA 94578-1132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2020 |
Last Update Date | 25/11/2020 |