Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 13880 | CA |
N | 226300000X | Kinesiotherapist |
NPI | 1255638946 |
---|---|
Provider Name | Miss Edith Carolina Torres-Lopez |
First Address | Modesto, CA 95355-3302 |
Second Address | Modesto, CA 95350-5436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2011 |
Last Update Date | 16/02/2011 |