Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033235601 |
---|---|
Provider Name | Miss Denise Leonie Landaverde |
First Address | Los Angeles, CA 90066-5882 |
Second Address | Los Angeles, CA 90066-5882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/02/2011 |