Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1795 | CA |
NPI | 1699131516 |
---|---|
Provider Name | Mr. Jon Ernie Ordaniel |
First Address | Los Angeles, CA 90034-5573 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2016 |
Last Update Date | 07/01/2016 |