Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1013493626 |
---|---|
Provider Name | Mrs. Glenda Josefina Moghim |
First Address | Sherman Oaks, CA 91403-4409 |
Second Address | Van Nuys, CA 91405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2018 |
Last Update Date | 18/11/2020 |