Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043794845 |
---|---|
Provider Name | Martha Hernandez |
First Address | Northridge, CA 91325-2003 |
Second Address | Northridge, CA 91325-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 18/09/2018 |