Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1013559897 |
---|---|
Provider Name | Mr. Willie D Hobdy |
First Address | Los Angeles, CA 90062-2604 |
Second Address | Los Angeles, CA 90062-2604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2019 |
Last Update Date | 12/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
812735555 | (05) | CA |