Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053575720 |
---|---|
Provider Name | Miss Magdalena Andrade |
First Address | La Puente, CA 91746-2534 |
Second Address | Irwindale, CA 91706-3752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 20/01/2009 |