Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023490539 |
---|---|
Provider Name | Liza Noemi Campos |
First Address | Pasadena, CA 91107-7102 |
Second Address | Chino, CA 91710-3530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 30/03/2021 |