Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 35986 | CA |
N | 2251C2600X | Cardiopulmonary |
NPI | 1134474877 |
---|---|
Provider Name | Komal Deokule |
First Address | San Diego, CA 92191-0883 |
Second Address | San Diego, CA 92108-1306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2012 |
Last Update Date | 14/11/2012 |