Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013298355 |
---|---|
Provider Name | Mrs. Karen Raquel Landaverde |
First Address | North Hollywood, CA 91606-1576 |
Second Address | West Covina, CA 91790-2725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2011 |
Last Update Date | 24/09/2020 |