Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1487 | CA |
NPI | 1669574380 |
---|---|
Provider Name | Mr. Kevin Mejia |
First Address | Long Beach, CA 90822-5201 |
Second Address | Long Beach, CA 90822-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 08/07/2007 |