Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053865535 |
---|---|
Provider Name | Miss Terrica Enjoli Stewart |
First Address | Gardena, CA 90248-3523 |
Second Address | Gardena, CA 90248-3523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2016 |
Last Update Date | 12/08/2016 |