Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT25592 | CA |
NPI | 1003028275 |
---|---|
Provider Name | Mrs. Deanna Michelle Vizon |
First Address | Riverside, CA 92507-0728 |
Second Address | Riverside, CA 92507-0728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 07/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT25592 | PT LICENSE (01) | CA |