Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 10255 | CA |
NPI | 1013430909 |
---|---|
Provider Name | Mrs. Cecilia Coronado |
First Address | Sylmar, CA 91342-1437 |
Second Address | Sylmar, CA 91342-1437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2017 |
Last Update Date | 21/07/2017 |