Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023393402 |
---|---|
Provider Name | Miss Angelique N Eady |
First Address | Los Angeles, CA 90013-1629 |
Second Address | Los Angeles, CA 90013-1629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2011 |
Last Update Date | 01/12/2014 |