Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT 1910 | CA |
NPI | 1013117407 |
---|---|
Provider Name | Mrs. Emily Guzman - Diaz Sevilla |
First Address | Chino, CA 91710-1513 |
Second Address | San Dimas, CA 91773-5108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 23/07/2007 |