Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | AT9008 | CA |
NPI | 1235361239 |
---|---|
Provider Name | Michellane Alvarez Baluyot |
First Address | San Gabriel, CA 91775-2719 |
Second Address | San Gabriel, CA 91775-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2009 |
Last Update Date | 08/01/2015 |