Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 34127 | CA |
NPI | 1285042325 |
---|---|
Provider Name | Mrs. Leonica Maglasang |
First Address | Stockton, CA 95209 |
Second Address | Stockton, CA 95209-4369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2014 |
Last Update Date | 31/07/2014 |