Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023140647 |
---|---|
Provider Name | Miss Mia Lynette Williams |
First Address | South Pasadena, CA 91030-2630 |
Second Address | South Pasadena, CA 91030-2630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 21/12/2017 |