Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT23583 | CA |
NPI | 1245346329 |
---|---|
Provider Name | Mrs. Jana Mitsue Smith |
First Address | Laguna Niguel, CA 92677-3933 |
Second Address | Laguna Niguel, CA 92677-3933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 25/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q42234 | (02) | CA |