Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | G61709 | CA |
NPI | 1053408021 |
---|---|
Provider Name | Marcia Ann Luisi |
First Address | Santa Rosa, CA 95404-4802 |
Second Address | Santa Rosa, CA 95404-4802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G617090 | (05) | CA |
E24864 | (02) | CA |