Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1023649811 |
---|---|
Provider Name | Morenike Roberta Banks |
First Address | Altadena, CA 91001-4925 |
Second Address | Pasadena, CA 91103-3050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2020 |
Last Update Date | 30/01/2020 |