Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1255815155 |
---|---|
Provider Name | Mary Alice Swiney |
First Address | Los Angeles, CA 90008-3730 |
Second Address | Los Angeles, CA 90008-3730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2018 |
Last Update Date | 18/09/2018 |