Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT 8288 | CA |
NPI | 1013305176 |
---|---|
Provider Name | Marilou Sison |
First Address | Los Angeles, CA 90029-1675 |
Second Address | Los Angeles, CA 90029-1675 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2014 |
Last Update Date | 24/12/2014 |