Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023361870 |
---|---|
Provider Name | Ms. Brigette Marie Machutta-Villalobos |
First Address | Reno, NV 89509-4862 |
Second Address | Reno, NV 89509-4862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2012 |
Last Update Date | 17/10/2012 |