Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053603142 |
---|---|
Provider Name | Martha Cobian |
First Address | Pomona, CA 91766-1123 |
Second Address | West Covina, CA 91790-2138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2011 |
Last Update Date | 06/05/2011 |