Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | IMF47867 | CA |
NPI | 1043341191 |
---|---|
Provider Name | Maura Callary |
First Address | Long Beach, CA 90803-6013 |
Second Address | Long Beach, CA 90806-2445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |