Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | CA |
NPI | 1285125088 |
---|---|
Provider Name | Liliana Monica Wood |
First Address | Laguna Niguel, CA 92607-7379 |
Second Address | Laguna Niguel, CA 92677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2018 |
Last Update Date | 29/05/2018 |