Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043338536 |
---|---|
Provider Name | Mrs. Carolina Trias-Fonseca |
First Address | Los Angeles, CA 90022-1845 |
Second Address | Monterey Park, CA 91754-7668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 02/10/2017 |