Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013345438 |
---|---|
Provider Name | Malia Patrocinio |
First Address | Las Vegas, NV 89179-1205 |
Second Address | Las Vegas, NV 89179-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2013 |
Last Update Date | 22/10/2013 |