Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT 9046 | CA |
NPI | 1013220045 |
---|---|
Provider Name | Mr. Ramon Vazquez JR. |
First Address | Chula Vista, CA 91911-2214 |
Second Address | Chula Vista, CA 91911-2214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2010 |
Last Update Date | 19/07/2010 |