Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1114356375 |
---|---|
Provider Name | Mark Corpuz |
First Address | San Diego, CA 92112-3817 |
Second Address | San Diego, CA 92108-6705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2013 |
Last Update Date | 07/11/2013 |