Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053456848 |
---|---|
Provider Name | Lisa Michele Nagel |
First Address | Commerce, CA 90040-1577 |
Second Address | Commerce, CA 90040-1570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 07/08/2008 |