Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053723916 |
---|---|
Provider Name | Ms. Crystal Marie Gudino |
First Address | Van Nuys, CA 91405-2210 |
Second Address | Van Nuys, CA 91405-2210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 27/05/2014 |