Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043523939 |
---|---|
Provider Name | Miss Nancy Gonzalez |
First Address | Los Angeles, CA 90042-1508 |
Second Address | Los Angeles, CA 90042-1508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2010 |
Last Update Date | 20/07/2010 |