Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC27959 | CA |
NPI | 1104848480 |
---|---|
Provider Name | Mary Trumpi |
First Address | Santa Monica, CA 90401-1886 |
Second Address | Santa Monica, CA 90401-1886 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 28/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V05234 | (02) | CA |