Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013102003 |
---|---|
Provider Name | Mrs. Susan Rosales |
First Address | Cudahy, CA 90201-5936 |
Second Address | Los Angeles, CA 90010-2501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 10/05/2013 |