Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40059 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | CA |
NPI | 1043803174 |
---|---|
Provider Name | Mrs. Gisella Xianne Plaza |
First Address | Aliso Viejo, CA 92656-0001 |
Second Address | Aliso Viejo, CA 92656-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2021 |
Last Update Date | 24/02/2021 |