Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | ||
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1235656463 |
---|---|
Provider Name | Laura Smith |
First Address | Los Angeles, CA 90004-2306 |
Second Address | Los Angeles, CA 90004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2017 |
Last Update Date | 09/10/2018 |