Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003589649 |
---|---|
Provider Name | Madison Foster |
First Address | Los Angeles, CA 90001-3409 |
Second Address | Los Angeles, CA 90001-3409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2021 |
Last Update Date | 29/07/2021 |