Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043498066 |
---|---|
Provider Name | Martha Alexandra Perez |
First Address | Pico Rivera, CA 90660-2405 |
Second Address | Pico Rivera, CA 90660-2444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2008 |
Last Update Date | 19/11/2011 |