Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043718570 |
---|---|
Provider Name | Laura Maldonado |
First Address | Los Angeles, CA 90042-1245 |
Second Address | Los Angeles, CA 90042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2018 |
Last Update Date | 29/05/2018 |